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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by sonic_gb on November 26, 2007, at 9:58:27
Hello All,
I have my first appointment with a psychiatrist next week. I am in the middle of a worsening period of major depression and anxiety that isn't responding to any drugs tried so far. I have had multiple treatment failures with various AD's. I have tried at least 5 different SSRI's, nefazodone, Effexor, Remeron, Wellbutrin SR, and Moclobemide. Out of all of those Moclobemide (a reversible MAOAI) worked best, but pooped out after three short great weeks. I would like to ask to be put on "real" MAOI, either Parnate or Nardil, since I had a good experience previously on a mini-MAOI. Apparently neither MAOI is really prescribed in my country except in extreme cases.
How should I present my case? Is there anything else that I should be considering at this point? This may be my only chance to see the psychiatrist, since there is a big shortage here, and they are "rationed" by the province.
Please help me prepare, I really need to feel better.
Thanks,
Sonic
Posted by FredPotter on November 26, 2007, at 13:55:24
In reply to MAOI's, Treatment resistant depression., posted by sonic_gb on November 26, 2007, at 9:58:27
Dear Sonic Nothing worked for me over 40 years of suffering until recently when I took Nardil, starting slowly but ending up on 90mg/day (1 mg per Kg body weight). It took 6.5 weeks to work and this period was troublesome (feeling drugged, dizzy, faint on standing), but then I felt great. The euphoria faded after a couple of weeks, leaving me feeling normal. Side-effects were belly fat and dissapearance of sexual function. There must be something to counteract this but have heard of no suggestions yet
All the best
Fred
Posted by stargazer2 on November 26, 2007, at 15:30:25
In reply to Re: MAOI's, Treatment resistant depression. » sonic_gb, posted by FredPotter on November 26, 2007, at 13:55:24
Sorry to hear of your 40 year struggle. That is remarkable that you had the will to persist and continue to fight on despite feeling depressed, etc. Did you have any periods of time during that 40 years that your symptoms receded to the point you could function relatively well and work?
Where do you live? Were you hospitalized because of it? Did you have ECT or other procedures like TMS or VNS?
I have a > 30 year history overall, but really a 25 year history starting with a therapist, then a pdoc that put me on Nardil as the second med I tried and bingo, I was cured until 2 years later when it pooped out. I then had 2 years of success with Marplan until Roche pulled it off the market in 1994. Then I had probably 10 years where my treatment was marginal taking every SSRI known to man until a combination of Celexa, wellbutrin and adderall helped for about 3-4 years.
This led up to the past year and a half when I crashed an becam unable to work or really do much of anything productive. I asked my pdoc if I could retry Marplan again (with no relief), Cymbalta and Emsam with various adjunctive meds,including Risperdal, Zyprexa, Geodon, Abilify, Lamictal and Seroquel. Probably not all of them, just the ones I remember.
Then at my insistence I retried the "New, unimproved" Nardil this past May and worked up to 60 mg with one relapse at 45 mg.
Nothing is easy as far as Treatment resistent depression(TRD) is concerned. There were many times I almost gave up.
Today I take Nardil, Synthroid (after seeing an endocrinologist)for his input on TRD, and just recently Deplin. I stopped the nortriptylline I was taking for about 4 months as I didn't think it was doing much of anything and there have been no changes at all having stopped it.
I'm happy to hear so many of us have responded to nardil and disappointed so many pdocs are not familiar with it, since it can work well for those with TRD, and I don't find the diet or precautions very difficult to follow.
Stargazer
Posted by Jedi on November 27, 2007, at 3:12:43
In reply to MAOI's, Treatment resistant depression., posted by sonic_gb on November 26, 2007, at 9:58:27
Hi,
Sounds like you are Canadian. I've found a general lack of knowledge about the irreversible MAOIs in Canada; at least among the pharmacists. Let's hope that your psychiatrist has some knowledge of the meds.I always write an introduction letter when I am seeing a new doctor. This stategy can backfire depending on the personality of your MD. If your depression is atypical; phenelzine, tranylcypromine, or isocarboxazid will be your best choices. Despite the name, atypical depression is really the most common type of depression. In addition to the core symptoms of depression, atypical depression is defined by the ability to feel better temporarily in response to a positive life event, plus any two of the following criteria: excessive sleep, overeating, a feeling of heaviness in the limbs and a sensitivity to rejection.
I usually print out a few citations from Pubmed that show the efficacy of the irreversible MAOIs on atypical depression. If you have social anxiety disorder along with the depression, Nardil or Marplan decrease the metabolism of GABA which can really help this disease. Like I said this startegy can backfire depending on the ego of your psychiatist and his willingness to listen to the patient.
Good Luck,
JediReferences:
> Hello All,
>
> I have my first appointment with a psychiatrist next week. I am in the middle of a worsening period of major depression and anxiety that isn't responding to any drugs tried so far. I have had multiple treatment failures with various AD's. I have tried at least 5 different SSRI's, nefazodone, Effexor, Remeron, Wellbutrin SR, and Moclobemide. Out of all of those Moclobemide (a reversible MAOAI) worked best, but pooped out after three short great weeks. I would like to ask to be put on "real" MAOI, either Parnate or Nardil, since I had a good experience previously on a mini-MAOI. Apparently neither MAOI is really prescribed in my country except in extreme cases.
>
> How should I present my case? Is there anything else that I should be considering at this point? This may be my only chance to see the psychiatrist, since there is a big shortage here, and they are "rationed" by the province.
>
> Please help me prepare, I really need to feel better.
>
> Thanks,
>
> Sonic
Posted by sonic_gb on November 27, 2007, at 8:36:38
In reply to Re: MAOI's, Treatment resistant depression. » sonic_gb, posted by Jedi on November 27, 2007, at 3:12:43
Jedi,
You're right, I'm Canadian. I really appreciate your comments, and I hope my meeting goes well. Actually I just found out that it is only with a psychiatric nurse who makes the decision as to whether or not I am permitted to see a psychiatrist. A little disappointing, but we'll see what happens.
Sonic
> Hi,
> Sounds like you are Canadian. I've found a general lack of knowledge about the irreversible MAOIs in Canada; at least among the pharmacists. Let's hope that your psychiatrist has some knowledge of the meds.
>
> I always write an introduction letter when I am seeing a new doctor. This stategy can backfire depending on the personality of your MD. If your depression is atypical; phenelzine, tranylcypromine, or isocarboxazid will be your best choices. Despite the name, atypical depression is really the most common type of depression. In addition to the core symptoms of depression, atypical depression is defined by the ability to feel better temporarily in response to a positive life event, plus any two of the following criteria: excessive sleep, overeating, a feeling of heaviness in the limbs and a sensitivity to rejection.
>
> I usually print out a few citations from Pubmed that show the efficacy of the irreversible MAOIs on atypical depression. If you have social anxiety disorder along with the depression, Nardil or Marplan decrease the metabolism of GABA which can really help this disease. Like I said this startegy can backfire depending on the ego of your psychiatist and his willingness to listen to the patient.
>
> Good Luck,
> Jedi
>
> References:
>
> http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&DbFrom=pubmed&Cmd=Link&LinkName=pubmed_pubmed&LinkReadableName=Related%20Articles&IdsFromResult=17474801&ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstractPlusDrugs2
>
>
>
> > Hello All,
> >
> > I have my first appointment with a psychiatrist next week. I am in the middle of a worsening period of major depression and anxiety that isn't responding to any drugs tried so far. I have had multiple treatment failures with various AD's. I have tried at least 5 different SSRI's, nefazodone, Effexor, Remeron, Wellbutrin SR, and Moclobemide. Out of all of those Moclobemide (a reversible MAOAI) worked best, but pooped out after three short great weeks. I would like to ask to be put on "real" MAOI, either Parnate or Nardil, since I had a good experience previously on a mini-MAOI. Apparently neither MAOI is really prescribed in my country except in extreme cases.
> >
> > How should I present my case? Is there anything else that I should be considering at this point? This may be my only chance to see the psychiatrist, since there is a big shortage here, and they are "rationed" by the province.
> >
> > Please help me prepare, I really need to feel better.
> >
> > Thanks,
> >
> > Sonic
>
>
Posted by FredPotter on November 28, 2007, at 13:52:55
In reply to Re: MAOI's, Treatment resistant depression/Fred., posted by stargazer2 on November 26, 2007, at 15:30:25
Stargazer sorry to be so long replying to your kind post
> Sorry to hear of your 40 year struggle. That is remarkable that you had the will to persist and continue to fight on despite feeling depressed, etc. Did you have any periods of time during that 40 years that your symptoms receded to the point you could function relatively well and work?
The sad thing is that Nardil was available when I was first assailed with nocturnal panic/depersonalisation/derealisation which is how it started. Then it started happeneing in the daytime. It took several years for depression to creep in I would say. Yes I had many periods of normality and happiness. eg my first year in university in a hall of residence was very neurotic and anxious, but I managed to get involved and passed my part 1 exams, started a band, became secretary of the Jazz Club etc.
As the past recedes it becomes clearer what was happening. In my second year I lodged with a family. That year was completely untroubled and happy. 3rd year in hall of residence and I eventually cracked up again. The same symptoms - they came as a terrible shock as I'd forgotten about them. Lying on the bed afraid to move, but if I did there was a terrible surge of panic.
In my first job I lodged again for a year and was very happy. I then shared a flat and these were very happy years. In other words I needed acutely the presence of others around me, although it was my tendency to run away and hide from the very thing that would make me well.
> Where do you live? Were you hospitalized because of it? Did you have ECT or other procedures like TMS or VNS?
I did live in Wales but for the last 11 years in New Zealand
I persuaded the psych to take me in voluntarily for a week. It did no good as they just ignored me except for a tiny dose of valium
> I have a > 30 year history overall, but really a 25 year history starting with a therapist, then a pdoc that put me on Nardil as the second med I tried and bingo, I was cured until 2 years later when it pooped out. I then had 2 years of success with Marplan until Roche pulled it off the market in 1994. Then I had probably 10 years where my treatment was marginal taking every SSRI known to man until a combination of Celexa, wellbutrin and adderall helped for about 3-4 years.
I'm sorry to hear MAOIs pooped out for you. I didn't think they were supposed to do this. Did you try raising the dose or augmenting? SSRIs have been no use for me
> This led up to the past year and a half when I crashed an becam unable to work or really do much of anything productive. I asked my pdoc if I could retry Marplan again (with no relief), Cymbalta and Emsam with various adjunctive meds,including Risperdal, Zyprexa, Geodon, Abilify, Lamictal and Seroquel. Probably not all of them, just the ones I remember.
>
> Then at my insistence I retried the "New, unimproved" Nardil this past May and worked up to 60 mg with one relapse at 45 mg.
>
> Nothing is easy as far as Treatment resistent depression(TRD) is concerned. There were many times I almost gave up.
>
> Today I take Nardil, Synthroid (after seeing an endocrinologist)for his input on TRD, and just recently Deplin. I stopped the nortriptylline I was taking for about 4 months as I didn't think it was doing much of anything and there have been no changes at all having stopped it.
>
> I'm happy to hear so many of us have responded to nardil and disappointed so many pdocs are not familiar with it, since it can work well for those with TRD, and I don't find the diet or precautions very difficult to follow.
>
> StargazerI suggested Nortriptyline augmentation to my Dr with the hope of lowering the Nardil dose and perhaps losing some weight. He concurred, but my pharmacist was horrified. Oh well nothing bad has happened yet
All the best
Fred
Posted by spaceboy68 on December 1, 2007, at 12:19:15
In reply to Re: MAOI's, Treatment resistant depression/Fred., posted by FredPotter on November 28, 2007, at 13:52:55
I mad at my self for how ageist this sounds but
I've had a problem being prescribed MAOIs if
the doctor is somewhat older my latest dr
who is just a GP was thrilled someone asked
him to go on Parnate.He said he wished more
people would take a chance and try it rather
sometimes suffer for years on typical
ADs.
Posted by mikez on December 3, 2007, at 1:51:55
In reply to Re: MAOI's, Treatment resistant depression/Fred., posted by spaceboy68 on December 1, 2007, at 12:19:15
For all those interested in MAOIs, I have heard that taking an NARI takes away any of the tyramine associated risks, since tyramine causes the displacement of noradrenaline which causes the increased blood pressure.
So could all the dietary hassles or risks simply be avoided by taking an NARI at the same time?
This is the end of the thread.
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