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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 34. This is the beginning of the thread.
Posted by stargazer on November 11, 2006, at 8:14:14
Hi all MAO users/experts,
I need some help with choosing a MAOI or similar type of med. I have taken Nardil, Parnate and Marplan in the past. This past year I tried Marplan again after a 10 year hiatus but without a good response. I had luck with Nardil once, but not the second time. Never had any luck with Parnate (tried 2x).
I know many of you have great expertise in understanding the pharmacological basis for how many of these meds work so I would like to know how to determine which MAO type drugs might work for me.
I have read some info on MAO-A vs MAO-B, but have trouble with cognitive abilities and have trouble sorting them out. I need simple explanations of how they work. I also read something on Deprenyl (Seligiline) and the PEA (Phenylethylamine) deficit as being a cause of depression. Is there any substanceto this theory? Has anyone used Deprenyl and D-Phenylalanine(where to buy?) successfully?
It makes me so angry that DEPRESSION is so poorly understood and after 25 years I continue to waste my life trying to get help. I'm starting to lose faith in my pdoc since all he ever says is "we don't know how the drugs work" I have gone to him for 15+ years and don't know if he can help me.
Currently I'm in a holding pattern having just come off Cymbalta and still on Seroquel 100 mg at night. The Seroquel was used to pull me out of a suicidal pattern and did do this.
Can anyone provide me with a website to go to, a list of MAO type drugs to try, etc.
I did discuss trying ENSAM next but wondered if there is something else to try first, since ENSAM may not be covered undere my insurance and costs up to $500 for 30 patches.MY symptoms involve self consciousness, poor cognition, inability to handle stress, low self esteem, some paranoia, inability to retain information, poor memory, tiredness, etc. Since I'm not in the midst of a depressive crisis now, it's hard to remember all of the true depressive symptoms I've had but overall I feel like being DEAD is preferable to being Alive.
I appreciate any help with trying to sort out the MAO's before MOnday so I can have a game plan to discuss with my pdoc.
Stargazer
Posted by med_empowered on November 11, 2006, at 10:38:37
In reply to NEED ADVICE...How to choose a MAO????????, posted by stargazer on November 11, 2006, at 8:14:14
maybe its time to try a kind of radical approach--MAOI plus augmenting agents. The most common combo I've seen discussed would be an MAOI plus a stimulant, such as dexedrine (though I imagine ritalin or provigil could work); you can also try MAOI+tricyclic or MAOI+tricyclic+stimulant, or throw in a benzo as-needed to any of these combos. That's pretty hardcore medicating, but its effective for some people...
if seroquel helped, maybe an MAOI plus full-dose atypical? Not my first choice, but some people respond well to neuroleptics.
Posted by Phillipa on November 11, 2006, at 11:36:42
In reply to NEED ADVICE...How to choose a MAO????????, posted by stargazer on November 11, 2006, at 8:14:14
Oh please let me follow your thread as I don't understand them at all. EMSAM I think I do but not the traditional. You sound very educated on them to me. Love Phillipa
Posted by josephine grandoni on November 11, 2006, at 23:01:26
In reply to NEED ADVICE...How to choose a MAO????????, posted by stargazer on November 11, 2006, at 8:14:14
> Hi all MAO users/experts,
>
> I need some help with choosing a MAOI or similar type of med. I have taken Nardil, Parnate and Marplan in the past. This past year I tried Marplan again after a 10 year hiatus but without a good response. I had luck with Nardil once, but not the second time. Never had any luck with Parnate (tried 2x).
>
> I know many of you have great expertise in understanding the pharmacological basis for how many of these meds work so I would like to know how to determine which MAO type drugs might work for me.
>
> I have read some info on MAO-A vs MAO-B, but have trouble with cognitive abilities and have trouble sorting them out. I need simple explanations of how they work. I also read something on Deprenyl (Seligiline) and the PEA (Phenylethylamine) deficit as being a cause of depression. Is there any substanceto this theory? Has anyone used Deprenyl and D-Phenylalanine(where to buy?) successfully?
>
> It makes me so angry that DEPRESSION is so poorly understood and after 25 years I continue to waste my life trying to get help. I'm starting to lose faith in my pdoc since all he ever says is "we don't know how the drugs work" I have gone to him for 15+ years and don't know if he can help me.
>
> Currently I'm in a holding pattern having just come off Cymbalta and still on Seroquel 100 mg at night. The Seroquel was used to pull me out of a suicidal pattern and did do this.
>
> Can anyone provide me with a website to go to, a list of MAO type drugs to try, etc.
> I did discuss trying ENSAM next but wondered if there is something else to try first, since ENSAM may not be covered undere my insurance and costs up to $500 for 30 patches.
>
> MY symptoms involve self consciousness, poor cognition, inability to handle stress, low self esteem, some paranoia, inability to retain information, poor memory, tiredness, etc. Since I'm not in the midst of a depressive crisis now, it's hard to remember all of the true depressive symptoms I've had but overall I feel like being DEAD is preferable to being Alive.
>
> I appreciate any help with trying to sort out the MAO's before MOnday so I can have a game plan to discuss with my pdoc.
>
> StargazerHow long were you on Parnate or Nardil? It took maybe two months before Nardil finally kicked in for me, but what a difference! I later tried all the newer drugs like Prozac amd many others in various combinations. Nothing worked like Nardil, but Nardil was hard to get and it has sexual side effects after a certain level. I then tried Parnate...in the beginning, it made my heart pound...it seemed awful, but stick with it..adjust the dose..they are really the best..it will work. It may take a few weeks.
Posted by stargazer on November 12, 2006, at 13:07:15
In reply to Re: NEED ADVICE...How to choose a MAO????????, posted by josephine grandoni on November 11, 2006, at 23:01:26
Josephine, and others...
So are you are Nardil or Parnate? and at what dosage?
I was looking at my notes from years ago and think I took Nardil 15 mg 2X day from 1987-1989. It stopped working in 1990. Then I took Marplan 30 mg from 1991 until 1994 until Roche discontinued the drug. I then tried Parnate 10 mg, increased to 30 mg, but with poor response.
I recently tried Marplan again, after hearing it had been rereleased and only got a minimal response. I then began Cymbalta at 30 mg, increasing to 60 mg with resultant severe headaches, going back to 30 mg, and then adding Seroquel, which snapped me out of the depths.
This past week I stopped the Cymbalta, am still on Seroquel (100 mg at night)and now need to add an AD for prevention of relapse.
Perhaps NARDIL would be the place to start?
Other than Nardil, Parnate, Marplan or Ensam,
what other AD's work by inhibiting MAO A or B.And what are the drugs that affect the MAO-B?
I know they re also used for Parkinson's patients (i.e. selegilene) but I don't know how they work for depression and what success others have hadon them for deprression.I am SO overwhelmed with trying to come up with answers for this myself. I have been faithfully working with my doctor to find the answer but realize that in 25 years we have not found the answer, as much as I have tried to do my own research. I am really angry about there never being a "fix" or a logical "game plan" to follow. It all just seems SO random, SO unstructured, SO uncertain. Does it have to be this way or is there really no better approach to treating depression?????
SG
Posted by josephine grandoni on November 12, 2006, at 13:53:15
In reply to MAO EXPERTS/USERS...Recommendations??????, posted by stargazer on November 12, 2006, at 13:07:15
I take 5 parnate a day, but I am inconsistent. I also take 1/2 of a Naltrexisone (?)...you might look into that. It was very good for me..It has many, many uses. I am not 100 percent happy with what I take...I am also looking for better meds. I am very anxious and often still depressed. I don't know what you mean by MAO A/B...?
Posted by stargazer on November 12, 2006, at 16:13:26
In reply to Re: MAO EXPERTS/USERS...Recommendations??????, posted by josephine grandoni on November 12, 2006, at 13:53:15
J,
I don't know anything about the other drug you take (Naltrexsone). I looked it up and wasn't sure what type of drug it is. Is it an antidepressant? Are you in the US or outside of the US? Some of the people on this website are from outside the US and the meds they take are different than the ones available in the US so occasionally the names are not familiar to me.
There are two types of MAO (monoamine oxidase), A and B, enzymes which breakdown certain neurotransmittors, including dopamine, norepinephrine and serotonin. I believe the types differ by where they are located in the body. I believe A is in the stomach, while B is in the Brain (CNS). The drugs typical for depression (Nardil, Parnate and Marplan) inhibit the MAO-A enzymes. The newer MAO drug, Ensam, affects the MAO-B enzyme. I don't really understand the significance between the A and B enzymes. It's quite confusing for a layperson, so other people can usually explain this stuff better to the rest of us, as long as they keep it simple.
I know Ensam has none of the dietary restrictions of the MAO-A drugs which is a huge advantage and is a patch, not an oral, form.
SG
Posted by stargazer on November 12, 2006, at 16:16:15
In reply to Re: MAO EXPERTS/USERS...Recommendations??????, posted by josephine grandoni on November 12, 2006, at 13:53:15
J,
I don't know anything about the other drug you take (Naltrexsone). I looked it up and wasn't sure what type of drug it is. Is it an antidepressant? Are you in the US or outside of the US? Some of the people on this website are from outside the US and the meds they take are different than the ones available in the US so occasionally the names are not familiar to me.
There are two types of MAO (monoamine oxidase), A and B, enzymes which breakdown certain neurotransmittors, including dopamine, norepinephrine and serotonin. I believe the types differ by where they are located in the body. I believe A is in the stomach, while B is in the Brain (CNS). The drugs typical for depression (Nardil, Parnate and Marplan) inhibit the MAO-A enzymes. The newer MAO drug, Ensam, affects the MAO-B enzyme. I don't really understand the significance between the A and B enzymes. It's quite confusing for a layperson, so other people can usually explain this stuff better to the rest of us, as long as they keep it simple.
I know Ensam has none of the dietary restrictions of the MAO-A drugs which is a huge advantage and is a patch, not an oral, form.
SG
Posted by Phillipa on November 12, 2006, at 17:20:27
In reply to Re: MAO EXPERTS/USERS...Recommendations??????, posted by stargazer on November 12, 2006, at 16:16:15
They say on the 9mg and l2mg patch the dietary restrictions are there but not that many of the ex-users did it. I think most of the posters are off it from insomnia. I've followed it as I wanted to try it. Liked the idea of a patch. Love Phillipa
Posted by josephine grandoni on November 12, 2006, at 17:39:52
In reply to Re: MAO EXPERTS/USERS...Recommendations?????? » stargazer, posted by Phillipa on November 12, 2006, at 17:20:27
The patch bypasses the stomach and goes directly to the blood stream therefore you would not have the dietary restrictions that pertain to mao inhibitors. The naltrexone is off-label..you could look up 'low dose naltrexone' or LDN...there is an organization that is trying to get it approved for a variety of problems. It helps with self-destructive behavior. I'm in New York. What are you taking now?
Posted by Phillipa on November 12, 2006, at 19:42:27
In reply to Re: MAO EXPERTS/USERS...Recommendations??????, posted by josephine grandoni on November 12, 2006, at 17:39:52
Very true but go to the official website EMSAM and 9 and l2mg patches follow the dietary guideline. I know it bypasses the gut which is one reason I love the idea of it as I took bioidentical hormones in cream form. And I couldn't tolerate the pill but somehow something you can see is soothing to me. I once posted here that if you ripped it off the med would be gone but then other EMSAM posters said it lasts for around 9 days. Are you on it? I'll love to hear from you. I'm an old Yankee Ct. Babblemail me and e-mail supplied. Love Phillipa
Posted by elanor roosevelt on November 13, 2006, at 11:36:59
In reply to Re: MAO EXPERTS/USERS...Recommendations?????? » stargazer, posted by Phillipa on November 12, 2006, at 17:20:27
i am also going to my doctor today
i will get a lecture because i have been withdrawing from parnate without seeking his advice
paranate was on of those drugs that fro me, convinced me i was so f**cked up and such a loser-- that it took me too long to realize it was the drugthe sadness and despair i have experienced on parnate makes me sucpicious of the entire category of drugs
-- i have not heard one good report here on emsam
(which the pharma companies are pitching like crazy to the docs)Nardil seems the one MAOI that I hear positive statements about
would love to know what you end up doing
i wish you the best
Posted by Phillipa on November 13, 2006, at 19:32:31
In reply to Re: MAO EXPERTS/USERS...Recommendations??????, posted by elanor roosevelt on November 13, 2006, at 11:36:59
Very true Eleanor even Robert David is off it now. No side effects just didn't need it. And Ed_uk highly recommends nardil for anxiety. Love Phillipa
Posted by josephine grandoni on November 13, 2006, at 20:55:26
In reply to Re: MAO EXPERTS/USERS...Recommendations?????? » elanor roosevelt, posted by Phillipa on November 13, 2006, at 19:32:31
i GOT ON THE WEB SITE FOR THE PATCH AND YOU ARE RIGHT..IT IS THE SAME DIETARY RESTRiCTIONS...i AM SURPRISED.. sorry for the caps...I haven't found any difference betweeen Nardil and Parnate but Parnate did not have the sexual side effects that Nardil did...above a certain dose...and, I could not get Nardil. I like Parnate, but I am always looking for a better drug...any recommendation?
Posted by stargazer on November 13, 2006, at 22:52:53
In reply to Re: MAO EXPERTS/USERS...Recommendations??????, posted by josephine grandoni on November 13, 2006, at 20:55:26
Eleanor, Phillipa, Josephine, et al...
I saw my pdoc today and although I wanted to try Nardil first, he suggested we start with Emsam. I could have pushed for Nardil, but I'm also interested in trying Emsam, so why not start there.
There are no dietary restrictions for the 6 mg patch so that is an advantage over Nardil. I was reading the insert tonight and a few items caught my eye. The biggest adverse effect was for skin reaction to the patch, around 22%. I will read again tomorrow and post about some of the other things I read. There was info on weight gain comparing Emsam to a placebo and there really wasn't any difference, I think it was around 2%, so that did not seem like a major adverse effect, as some here had suggested.
My pdoc said I have to be off Cymbalta X 14 days but after reading the insert I believe it said a 1 week period of washout, so I have to verify this and call him if I'm correct. Thank God I can read this stuff, although the print is so small, it takes forever to find the relevant data and then to understand it. If what I read is true, I can start Emsam this week rather than waiting until next week. I hope I can start this week,no time is like the present. I may start a new thread on Ensam since SLS isn't taking it and the thread doesn't really help with knowing who is taking it and how others are faring on it. I hope there are some with good results since so many have panned it. I am optimistic that there is a good chance for success.
Good night all. Time to take my seroquel which I will stay on for now. I think my pdoc is afraid for me to come off it, even though we're not sure what it is doing, for fear that I will plunge again, even if my relative stability is from a placebo effect.
SG
Posted by Phillipa on November 13, 2006, at 23:50:41
In reply to Re: MAO EXPERTS/USERS...On to ENSAM, posted by stargazer on November 13, 2006, at 22:52:53
Stargazer the worst side effect I've e-mailed with a lot of the EMSAM users is insomnia. So keep the seroquel. And the patch is sometimes removed at night to help avoid the insomnia. Hydrocorisone cream is used if you get a rash that isn't bad. And rotate the sites. A lot of babblers liked their upper back . Love Phillipa
Posted by psychobot5000 on November 14, 2006, at 17:05:20
In reply to NEED ADVICE...How to choose a MAO????????, posted by stargazer on November 11, 2006, at 8:14:14
Hi. I read that someone was wondering about the difference between the different MAOis and how they worked, so here's my attempt to sketch out the basics. Hope it's helpful.
____
MAO (MonoAmineOxidase) is a type of enzyme that metabolize/break down neurochemicals, by oxidizing them. The chemicals they break down are (mostly) serotonin, norepinephrine, and dopamine. All of these are thought to be important in depression, as well as other important brain function. The MAO inhibitors block the enzyme, preventing it from destroying these chemicals, and so creating higher levels all throughout the body.There are indeed two kinds of monoamine-oxidase: MAO-A and MAO-B. MAO-A breaks down serotonin and norepinephrine, while MAO-B breaks down dopamine--this is the main difference between the two. It is hard to summarize what each of these chemicals is used for because the subject is so damnably complicated, but broadly speaking, serotonin is thought to be involved in mood, anxiety, digestion, sleep, and other things. Norepinephrine/Noradrenaline (same thing) is involved in drive, wakefulness, heartrate, and much else. Dopamine is involved in memory, learning, movement, drive/motivation, pleasure...the list goes on.
The first antidepressants were unselective MAO inhibitors, meaning that they block BOTH MAO-A and MAO-B. (Nardil, Parnate and Marplan are all of this type) MAO is responsible for breaking down the chemical tyramie that is found in some foods, and causes dangerously increased heartrate and bloodpressure. Anyway, as long as a certain amount of -either- MAO-A or MAO-B is there, unblocked, in the gut, tyramine is prevented from flooding your system. Thus, moclobemide, a selective MAO-A inhibitor, which leaves MAO-b alone, is safe without dietary restrictions, and EMSAM, which prefers MAO-B greatly, is also safe in moderate doses. In either case (unless they are taken together), one half of the MAO is still available to keep your system safe.
So there are three main types of MAO inhibitors:
1) The old, powerful inhibitors of MAO A and B, Nardil, Parnate, and Marplan. Perhaps because of their dual action, these are the most powerful chemical antidepressants medicine has. They are also dangerous because of tyramine, of course.
2)Inhibitors of MAO-A--Moclobemide (not used in the United States) and others. Among the least powerful antidepressants, the focus on MAO-A means they would elevate levels of serotonin and noradrenaline only. This makes them similar to other antidepressants like tricyclics, though tricyclics affect these chemicals with a different mechanism.
3) Inhibitors of MAO-B--Like Selegiline EMSAM. They affect primarily MAO-B and thus, increase dopamine. When taken through the patch, EMSAM doesn't pass directly through the digestive system, and thus has less effect on digestive MAO. The 6mg dose is safe from tyramine interactions. The 9mg and 12mg MAY BE safe as well, however, not enough research has been conducted at that dose, so we don't know.
Another MAO-B inhibitor is Azilect/Rasagiline, which is cleared in the US for parkinson's disease. It has been little-studied in depression, but could (possibly) be as effective as selegiline, if used in high enough doses.
Each individual drug is different. For example, both Parnate/Tranylcypromine and Selegiline/EMSAM metabolise into amphetamine, giving them, and Parnate particularly, more of a peppy feeling, and maybe causing more insomnia. EMSAM has much less of this than oral selegiline, because it goes straight into the blood without being processed by the liver first, as oral is. Selegiline is also a dopamine reuptake-inhibitor, giving it some further impact on dopamine. Some posters on this site believe EMSAM from the patch is more energizing than the oral form, probably because there is a higher ratio of the original substance to the other stuff produced when it passes through the liver from the intestine.
Remember that Parnate is an unselective MAOi, and in fact is clearly the most dangerous in terms of hypertensive crises. Maybe this is because of the modest stimulant effect that automatically goes with it.
Nardil/Phenelzine is unselective (meaning it is not choosy about MAO-A or B) drug that is thought by some to be slightly more powerful than the others. It is especially useful in anxiety, possibly because it also increases levels of GABA in the brain. GABA is an 'inhibiting' neurochemical, the same chemical that diazepam, xanax, and the many other drugs effect. Phenelzine/Nardil is probably also better for sleep than Parnate. Marplan is similar to Phenelzine. It may be less powerful, and have less effect on GABA, but also fewer side-effects. Both of these can be damaging to the liver, though, so one needs to have blood-checks of liver enzymes while taking them.
As far as I know, the theories about deprenyl(selegiline) and phenylethylamine in depression are largely unsubstantiated in terms of hard evidence, but selegiline does indeed increase phenylethylamine levels a great deal, by preventing its breakdown. Because EMSAM/selegiline/deprenyl effects dopamine, as well as these other such chemicals, it COULD be more useful for depressive states with cognitive difficulty than the other MAOis--or at least it might help this stuff just as much with fewer side-effects.
I hope this helps explain some stuff,
P-bot
Posted by Phillipa on November 14, 2006, at 18:12:49
In reply to Some MAOi information..., posted by psychobot5000 on November 14, 2006, at 17:05:20
PR great job even I could understand. The problem is remembering. But I will remember that EMSAM affects dopamine. Thanks, Phillipa
Posted by stargazer on November 14, 2006, at 18:23:52
In reply to Some MAOi information..., posted by psychobot5000 on November 14, 2006, at 17:05:20
Pbot,
Thank you so much for that great summary of MAO stuff. I was able to read all of it and understand it so that helped. It's nice when that happens.
BTW, when I'm depressed which is most of time (dysthymia) I have cognitive difficulties. I used to be able to learn, read and focus. Over the past few years I have had more and more difficulty reading with minimal retention. I can't prioritize tasks or stay focused on anything. The biggest part of my depression is getting overwhelmed with details and not being able to feel in control of anything. I tell my husband that I can't remember things, lately I feel incapable of working because I don't trust that my brain functions normally. I still feel intelligent but I am unable to use it in any productive way. Even articulating what occurs is difficult since I have trouble explaining how it feels.
Interestingly, now that I'm off all meds except for seroquel(while awaiting the start of Emsam) I feel my brain is working better than it has in years. This tells me that the medications I have been on are not really helping med but making me feel "stupid", forgetting I'm depressed. I don't read much anymore due to my poor retention and focus. It really sucks.
I pray Emsam will allow me to retain my cognitive abilities and perhaps improve them, along with preventing depression from recurring.
Is that too much to ask from a med?
SG
Posted by Phillipa on November 14, 2006, at 20:03:37
In reply to Re: Some MAOi information..Great info Pbot., posted by stargazer on November 14, 2006, at 18:23:52
No not at all. And what did you come off of? I'm beginning to think like Link about the meds. Love Phillipa
Posted by josephine grandoni on November 14, 2006, at 21:17:28
In reply to Re: Some MAOi information..Great info Pbot. » stargazer, posted by Phillipa on November 14, 2006, at 20:03:37
This has been so informative..I take Parnate.. the general feeling about Parnate seems to be that it is not good? To SG, I understand that you feel you can't remember, but you don't come across that way in your writing...you are very articulate and sensitive. I think that it is exciting that you are trying the patch. Does anyone know a good doc in New York?
Posted by psychobot5000 on November 14, 2006, at 22:38:29
In reply to Re: Some MAOi information..Great info Pbot., posted by josephine grandoni on November 14, 2006, at 21:17:28
I'm not certain it's fair to say that Parnate isn't good, though I've never personally tried it. There are some babblers who like Nardil better, but several people prefer Parnate. It has the advantage of being less damaging to the liver, and of having generally fewer side-effects, according to my books and docs.
But you really, really need to watch out for tyramine on Parnate--more than with the other MAOIs--it's very important. And it seems to be the worst of them for insomia, as far as I can tell.
Posted by Phillipa on November 14, 2006, at 22:45:01
In reply to Re: Parnate, posted by psychobot5000 on November 14, 2006, at 22:38:29
That's what Ed_uk always wants me to try for my anxiety/depression. Love Phillipa wish he wasn't working I miss him
Posted by CrimsonVik on November 15, 2006, at 0:48:56
In reply to Re: MAO EXPERTS/USERS...Recommendations?????? » stargazer, posted by Phillipa on November 12, 2006, at 17:20:27
> They say on the 9mg and l2mg patch the dietary restrictions are there but not that many of the ex-users did it. I think most of the posters are off it from insomnia. I've followed it as I wanted to try it. Liked the idea of a patch. Love Phillipa
I don't have any Emsam insomnia. Started it the 1st.
Posted by Phillipa on November 15, 2006, at 18:47:24
In reply to Re: MAO EXPERTS/USERS...Recommendations?????? » Phillipa, posted by CrimsonVik on November 15, 2006, at 0:48:56
Really is it working for you? I so want to try it. And Stargazer started it today. Love Phillipa ps are you taking anything else with it or removing it at night? Trying to cover the bases from the past users.
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