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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by Phillipa on May 5, 2007, at 12:53:59
A side track after reading some threads a different stance for learning how many people want MAOI's and either can't get a doc or have had back luck on them or just don't want to go that route. This is purely to obtain info. PJ
Posted by Racer on May 5, 2007, at 21:05:19
In reply to Curious Do A Lot of People Want MAO's and Cant get, posted by Phillipa on May 5, 2007, at 12:53:59
I am no expert, but this much I do know: MAOIs are not considered first line treatments for depression. There are a variety of reasons for this, involving safety and the dietary restrictions. Many doctors are out of practice regarding these drugs, and will go first to medications they have more experience with, or which are safer in overdose.
Additionally, a surprising number of people still get antidepressants from GPs. I wouldn't expect a GP to be eager to prescribe an MAOI these days.
So, those are a couple of issues. I would suspect that many doctors who are willing to prescribe MAOIs still want their patients to try other medications first, for reasons relating to safety.
I'll look forward to reading what others have to say on this.
Posted by Quintal on May 5, 2007, at 22:48:53
In reply to Curious Do A Lot of People Want MAO's and Cant get, posted by Phillipa on May 5, 2007, at 12:53:59
Are you also interested in positive experiences with MAOIs PJ? I had two different pdocs prescribe MAOIs at my request, both were reluctant and would never have done on their own initiative, but by that time I'd tried nearly everything else in the book so MAOIs were a reasonable suggestion.
The first MAOI I took was moclobemide (technically a RIMA) and that was prescribed by my GP. I felt no effect from it at all besides insomnia during the first week and I took it for six months in total. Marplan was the second MAOI, and I started that after a two week washout from moclobemide. I was surprised by the lack of side effects, and it was easily among the most tolerable meds I've ever taken. Unfortunately my pdoc refused to raise the dose above 30mg and that wasn't enough to do serious justice to my anxiety (I was also tapering off Klonopin at the time).
I started Parnate in February last year and did very well on it, but again the pdoc would only prescribe 30mg max and Parnate only worked for me at 80-120mg so I had to quit.
Q
Posted by Jedi on May 6, 2007, at 3:09:53
In reply to Re: Curious Do A Lot of People Want MAO's and Cant get » Phillipa, posted by Quintal on May 5, 2007, at 22:48:53
...
> I started Parnate in February last year and did very well on it, but again the pdoc would only prescribe 30mg max and Parnate only worked for me at 80-120mg so I had to quit.
>
> QHi Q,
Yes, I have personal experience with PDOCS dead set against MAOIs. Reading about your situation: IMHO, being unwilling to go beyond a 30mg dose of Parnate is just a waste of time for the patient. In order for these meds to work, the degree of MAO Inhibition is going to need to approach 90%. Very few people will get to this level on 30mg. I can see why you have had to take over your own prescribing. Of course, this is dangerous except for the most educated and careful people. I'm from a small town of about 50,000 people. There are maybe three or four PDOCs and none have even educated themselves about MAOIs. I'm lucky, in that if I do the research to back up what I say, and present it with scientific studies, my GP will usually go along with my suggestions. Reminds me of the post where a doctor thought tranylcypromine or phenelzine was for athletes foot!When you are really sick it is hard to research these things. But, as I've posted before, using MAOIs puts you at a different level of responsibility. Before I realized this, I had used a MD and a pharmacist with misinformation that almost killed me. I won't repeat the stories now, but they are true. I now double and triple check anything that I use along with a MAOI.
From your posts, it sounds like you've found a combination that is safe and works for you. Again, not everyone can do this. But, there is no one out there that cares about us getting well like we do. Or knows our body and it's reactions like we do.
Be Well,
Jedi
Posted by willyee on May 7, 2007, at 8:03:10
In reply to Re: Curious Do A Lot of People Want MAO's and Cant, posted by Racer on May 5, 2007, at 21:05:19
> I am no expert, but this much I do know: MAOIs are not considered first line treatments for depression. There are a variety of reasons for this, involving safety and the dietary restrictions. Many doctors are out of practice regarding these drugs, and will go first to medications they have more experience with, or which are safer in overdose.
>
> Additionally, a surprising number of people still get antidepressants from GPs. I wouldn't expect a GP to be eager to prescribe an MAOI these days.
>
> So, those are a couple of issues. I would suspect that many doctors who are willing to prescribe MAOIs still want their patients to try other medications first, for reasons relating to safety.
>
> I'll look forward to reading what others have to say on this.I have to disagree,while i believe there are plenty of docs who know the drugs and are concerned with the safety issue,i personaly believe if they knew it well more of them would take pre caution but still be using them more.
I personaly believe a good majority of docs learn what they do in school,which i imagine is enormous to get their degree.
However like myself in my profession what i learned in school is a 360 from what i had to learn working in the actualy field,as well as my knowledge became much more oriented on my everyday dealings opposed to what i learned in school which tends to fade in the distance.
My point is i believe a lot of docs keep sharp from a multitide of things which include rep visits where some information is given on a drug,as well as seminiars which i know they frequently attend.
This melts to the last and main sceniro which is they learn from daily use,seeing patients constantly through the day,day in and out on a semi similiar grouping of drugs the doc begins to learn more the most common side effects of the drug,the most lentgh to achieve effect,and much more,this is again from having a days full of patient feed back on the drugs.
So to seti aside this general working and blow the dust off a very old drug for a single patient or so who is requesting it id imagine for most docs simply would not be worth it.You have for example 50 patients on farily new drugs to which you have a lot of present day understanding,youre not gonna have one outside the park on a older drug that for the most part the MAIN thing you remeber is simply the fact it was said to be dangerous,your probuably not gonna choose to take aside time to read into this drug to find out the very latest,then take responsability for it,when you can simply refuse and offer what you truly believe for all the reasons stated is the better option anyway.
In order for a doc to use a maoi,three things will likly be the back bone.
1.As in my case it was an older doc,who remebered very well when its use was common so with my strong desire narrowly allowed me to go on it.
2.A doc who has built and feels a great trust in you as a single patient,values your input a great deal,and values information you bring to them opposed to a common problem ive had where docs go on a major defense when i attempt to give them any info,i get the feeling as if they believe me doing this implies i dont value there work alone.
3. A doc,i personaly only seen this once on a student/doc who is very much still into the profession,and enjoys learning more and not contempt with the degree and buisness they have establised.This would be a doc willing to take there own time and read the latetest very much updated information on these old drugs,and be very much more likly to consider it.
Unfortunatly the most i myself have seen localy are docs pull at the PDR,use that half of page which we all know is very general,and address any requests,such as a higher dose,a possable augment,etc by,from that pdr snippet.If the pdr snippets for parnate/nardil which are extremly similiar almost identical were to be updated and changed,i believe the use of the med would be much more allowed.
Last in reality the truth is while maois will carry some of the serious dangers they are notorious for,its also true that it goes up aganist what is now known about ssris a danger just as serious,.....while begining most ssris,the first few weeks are likly to worsen depression or cause sucideal ideation,and a patient on these drugs need to be closly suprervised during this time.
That side effect i feel ranks right up there with the maoi precatuions,and in ending,believe it all comes down to but not limited of the drugs being old,being cheap,not being strongly marketed or presented to docs by reps,and so on.This being the case gives no reasonable incentive for a doc to go out of the norm for a single patient or so.Again this is just from my general view of at least 20 docs in my life.
This is the end of the thread.
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