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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by bearfan on May 18, 2010, at 0:19:36
Just wanted to know, because it's such a hassle to find someone willing to prescribe it and then washing out your system several weeks just to start. Plus it makes the idea of polypharmacy much more tricky. Someone mentioned the phrase "Chasing the Dragon", because when I first took prozac it helped so much and I was optimistic. Now that it doesn't work as well anymore, I'm looking for alternatives and nothing has helped nearly as much. The closest ones were Effexor and Cymbalta, but the side effects were either bad sexual dysfunction or bad bloating and weight gain (Cymbalta). Anyone else been there? Someone said going up to 150mg to 225 gets rid of low libido on Effexor, and that Pristiq isn't as bad (my brief trial with it wasn't the same calming as effexor).
Posted by SLS on May 18, 2010, at 8:27:30
In reply to Are MAOIs really that much betters?, posted by bearfan on May 18, 2010, at 0:19:36
> Just wanted to know, because it's such a hassle to find someone willing to prescribe it and then washing out your system several weeks just to start. Plus it makes the idea of polypharmacy much more tricky. Someone mentioned the phrase "Chasing the Dragon", because when I first took prozac it helped so much and I was optimistic. Now that it doesn't work as well anymore, I'm looking for alternatives and nothing has helped nearly as much. The closest ones were Effexor and Cymbalta, but the side effects were either bad sexual dysfunction or bad bloating and weight gain (Cymbalta). Anyone else been there? Someone said going up to 150mg to 225 gets rid of low libido on Effexor, and that Pristiq isn't as bad (my brief trial with it wasn't the same calming as effexor).
MAOIs certainly do things biologically that other drugs do not. Your chances of responding to one of them are greater if you have atypical depression that started early in life. They are also worth considering if an anxiety disorder (GAD SAD OCD) is present.http://www.ncbi.nlm.nih.gov/pubmed/6375621
http://www.ncbi.nlm.nih.gov/pubmed/19741592
Correct me if I'm wrong. I gather that SNRIs are at least partially effective, but you are not happy with the side effects? Nardil can produce anorgasmia. It sometimes disappears with continued treatment, though. Some people get edema. Most people gain weight. Both Nardil and Parnate can produce hypotension, although this can be mitigated by maintaining electrolytes (sodium and potassium) and using the drug Florinef (fludrocortisone) if necessary. Marplan is less apt to produce these side effects, but has a reputation of being weaker than the other two.
Is an MAOI worth trying for you? I don't know. What are your alternatives?
- Scott
Posted by SLS on May 18, 2010, at 8:32:37
In reply to Re: Are MAOIs really that much betters? » bearfan, posted by SLS on May 18, 2010, at 8:27:30
> Is an MAOI worth trying for you? I don't know. What are your alternatives?
I forgot to ask what drugs you have tried already. Perhaps there are treatment alternatives that you are not aware of.
- Scott
Posted by Phillipa on May 18, 2010, at 11:13:38
In reply to Re: Are MAOIs really that much betters? » SLS, posted by SLS on May 18, 2010, at 8:32:37
Just my feeling I feel it's how bad is the depression and what are you willing to give up. Not all do well on Maoi's. Phillipa
Posted by bearfan on May 18, 2010, at 15:30:45
In reply to Re: Are MAOIs really that much betters? » SLS, posted by SLS on May 18, 2010, at 8:32:37
I do have atypical depression. I have tried the SSRIs at the standard dose, tried Wellbutrin only briefly (difficult to tolerate) I am interested in moclobemide, the reverisble MAOI, and I have some samples of that. I have been on Tofrnail PM the last 2 weeks and have gained 5 pounds already with no change in diet. Sleep is better, but the urination thing is annoying (slightly better now, but still present.)
Posted by stargazer2 on May 18, 2010, at 16:13:47
In reply to Are MAOIs really that much betters?, posted by bearfan on May 18, 2010, at 0:19:36
MAO's are a whole different classification of meds, so it does warrant a trial if you have not responded to any of the other typical meds used.
You say you had responses on many meds and yet I tried all of those with very poor results, but have responded to both Nardil and Marplan.
I always hold out hope that they will work each time I try them but the last one I was on, Nardil, only worked when I combined it with meds that are usually contraindicated, but I begged my doc to let me try them in combo with Nardil.
Personally I had the best results when I was first on Nardil and then Marplan and after years went by, they did not work a second time. IN between I tried all the newer "improved" meds (prozac, Effexor, Paxil, Zoloft, Cymbalta)with mixed results.
That is the frustration of having this condition versus hypertension or diabetes. There is no way of knowing if anything will work without the experiments and side effects. I couldn't work for years and lost so much time to this, I could write a book but it would be too depressing. And the condition, at least for me, doesn't go away so it is a lifetime of these trials.
I wish I had a pseudo depression that comes once or twice every few years but will resolve on its own. That would have been a blessing other than this one I was blessed with...based on faulty genetic defects, I'm now convinced of.
Sorry, to digress, but by all means if you are at your wits end, they can work, many here will agree with this.
Posted by bearfan on May 18, 2010, at 16:46:33
In reply to Re: Are MAOIs really that much betters?, posted by stargazer2 on May 18, 2010, at 16:13:47
What about the rima class as moclombermide ? . Seems like there is sound scientific evidance that it works but no where at the level as the older heavy hitters . More like first line
Posted by Phillipa on May 18, 2010, at 20:18:04
In reply to Re: Are MAOIs really that much betters?, posted by bearfan on May 18, 2010, at 16:46:33
Bearfan what does your doc wish you to try? The older meds first, new meds, combos, aren't the RIMAS something with three? Phillipa
Posted by Phillipa on May 18, 2010, at 20:23:26
In reply to Re: Are MAOIs really that much betters?, posted by bearfan on May 18, 2010, at 16:46:33
I can't find Rima's? Phillipa
Posted by vaisforlovers on May 20, 2010, at 21:55:23
In reply to Are MAOIs really that much betters?, posted by bearfan on May 18, 2010, at 0:19:36
I have been on Nardil since 2002. It saved my life. I was also on the verge of ECT, but was able to put it off. I feel so much better but my interests such as reading and gardening haven't come back. But I also could attribute that to laziness! I haven't had to watch my diet and I am on many contraindicated drugs such as Roxicodone and Vyvanse. I have never had a hypertensive crisis. And I was even given Demerol during a surgery which is the only drug that has caused a death. So in my humble opinion it is a great class of drugs and more and more doctors are using them.
Joanne
Posted by jedi on May 23, 2010, at 1:04:52
In reply to Re: Are MAOIs really that much betters? » bearfan, posted by Phillipa on May 18, 2010, at 20:23:26
> I can't find Rima's? Phillipa
Phillipa, RIMAs are also referred to as RMAOIs or reversible monoamine oxidase inhibitors. The primary example being Moclobemide. This medication is not available in the US but can be obtained in Canada. Most say it does not work nearly as well as the irreversible MAOIs, Nardil, Parnate & Marplan.
reference:
http://www.seratis.net/page5/page19/page40/page40.html
Be Well,
Jedi
Posted by Brainbeard on May 23, 2010, at 15:03:06
In reply to Are MAOIs really that much betters?, posted by bearfan on May 18, 2010, at 0:19:36
Posted by Phillipa on May 23, 2010, at 18:41:47
In reply to Re: Are MAOIs really that much betters? » Phillipa, posted by jedi on May 23, 2010, at 1:04:52
Jedi thanks you are always so patient with me. Phillipa
Posted by jedi on May 23, 2010, at 23:35:55
In reply to Nah. Considered imipramine yet? (nm), posted by Brainbeard on May 23, 2010, at 15:03:06
If your depression is treatment resistant, atypical with social anxiety:
NO CONTEST
Jedihttp://www.ncbi.nlm.nih.gov/pubmed/17474800
Clin Psychiatry. 2007 Apr;68(4):e10.
Treating DSM-IV depression with atypical features.Stewart JW, Thase ME.
Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA.
AbstractDepression with atypical features is characterized by mood reactivity and 2 or more symptoms of vegetative reversal (including overeating, oversleeping, severe fatigue or leaden paralysis, and a history of rejection sensitivity). Another important feature of atypical depression is its preferential response to monoamine oxidase inhibitor (MAOI) treatment, especially phenelzine, relative to tricyclic antidepressants (TCAs). The efficacy of newer agents relative to MAOIs and TCAs is unclear. This presentation reviews currently available treatments for DSM-IV depression with atypical features, focusing specifically on placebo-controlled trials. Although phenelzine shows the most efficacy in this population, treatment with TCAs, selective serotonin reuptake inhibitors, cognitive-behavioral therapy, MAOIs other than phenelzine, and other agents are discussed. Following this presentation is a discussion on the treatment of depression with atypical features by experts in this subject area.
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