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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 19 of 19. This is the beginning of the thread.
Posted by tensor on March 14, 2012, at 13:37:29
For anxious/phobic, unipolar, probably atypical and endogenous depression. I have problems with concentrating and fatigue, does not seem to respond to bupropion. Parnate or Nardil?
Thanks.
Posted by europerep on March 14, 2012, at 16:45:36
In reply to MAOI, posted by tensor on March 14, 2012, at 13:37:29
If the diagnosis 'atypical depression' is definitely established, it's Nardil (phenelzine).
Phenelzine has been shown to be significantly more effective in atypical depression than in other types of depression. It's also known to have considerable anxiolytic potential.
Good luck!
Posted by tensor on March 14, 2012, at 17:10:48
In reply to Re: MAOI » tensor, posted by europerep on March 14, 2012, at 16:45:36
> If the diagnosis 'atypical depression' is definitely established, it's Nardil (phenelzine).
I'm not sure, I would have to be without meds for awhile to see the true nature of my depression, and it's been a long while on meds.
> Phenelzine has been shown to be significantly more effective in atypical depression than in other types of depression. It's also known to have considerable anxiolytic potential.
>
> Good luck!Thanks.
Posted by tensor on March 14, 2012, at 17:39:04
In reply to Re: MAOI » tensor, posted by europerep on March 14, 2012, at 16:45:36
> If the diagnosis 'atypical depression' is definitely established, it's Nardil (phenelzine).
>
> Phenelzine has been shown to be significantly more effective in atypical depression than in other types of depression. It's also known to have considerable anxiolytic potential.
>
> Good luck!I have done extensive research on the web and the s/e profile of Parnate seems to be more benign, less weight gain, less sexual dysfunction. Nardil can also be hard on the liver, but overall better for (social) anxiety and less prone to hypertensive crises. Hard to pick one.
An MAOI is likely to be my next med to try and so far I'm leaning slightly towards Parnate. It sure would be nice to wipe off all my meds from my regime except clon and go monotherapy.
A problem I'm facing apart from the obvious ones with MAOIs is that they are rarely used here, which results in inexperienced pdocs and possibly a hospital not knowing how to deal with MAOI and hypertensive crisis. I don't know really how educated they are in these matters. I do gonna bring this up with my pdoc next appointment in about two weeks.MAOI Users, do you carry around anti-hypertensives like nifedipine all the time? Do you use medical bracelets?
Thanks.
Posted by emmanuel98 on March 14, 2012, at 19:35:10
In reply to Re: MAOI » europerep, posted by tensor on March 14, 2012, at 17:39:04
>
> MAOI Users, do you carry around anti-hypertensives like nifedipine all the time? Do you use medical bracelets?The NYTimes had an article not to long ago about the law in the US to limit residents hours. It was spearheaded by a journalist whose daughter died in the ER for unknown reasons. It is now known that she was taking nardil, nobody knew this, the residents gave her demerol and she died of serotonin syndrome.
It is still true that most docs know nothing about MAOIs, including most (young) p-docs. I wear a medical alert bracelet.
Posted by Phillipa on March 14, 2012, at 21:14:32
In reply to Re: MAOI, posted by emmanuel98 on March 14, 2012, at 19:35:10
How sad:( Phillipa
Posted by tensor on March 15, 2012, at 2:20:16
In reply to Re: MAOI, posted by emmanuel98 on March 14, 2012, at 19:35:10
> The NYTimes had an article not to long ago about the law in the US to limit residents hours. It was spearheaded by a journalist whose daughter died in the ER for unknown reasons. It is now known that she was taking nardil, nobody knew this, the residents gave her demerol and she died of serotonin syndrome.
:(
> It is still true that most docs know nothing about MAOIs, including most (young) p-docs. I wear a medical alert bracelet.
>Are you taking Nardil or Parnate?
Posted by emmanuel98 on March 15, 2012, at 19:08:08
In reply to Re: MAOI » emmanuel98, posted by tensor on March 15, 2012, at 2:20:16
> Are you taking Nardil or Parnate?
Parnate
Posted by brklyn2311 on March 16, 2012, at 3:07:21
In reply to MAOI, posted by tensor on March 14, 2012, at 13:37:29
Parnate actualy plays nice with a lot of meds you can use to augment.Low dose stims,most sedatives etc.Unless the old nardil comes back parnate is the only drug ill ever touch again.
Posted by tensor on March 16, 2012, at 3:37:37
In reply to Re: MAOI, posted by brklyn2311 on March 16, 2012, at 3:07:21
> Parnate actualy plays nice with a lot of meds you can use to augment.Low dose stims,most sedatives etc.Unless the old nardil comes back parnate is the only drug ill ever touch again.
I have to admit I'm scared about MAOIs, their potential for hypertensive crisis and serotonin syndrome. Don't know how exaggerated my fears are.
Posted by SLS on March 16, 2012, at 6:03:21
In reply to Re: MAOI » brklyn2311, posted by tensor on March 16, 2012, at 3:37:37
> > Parnate actualy plays nice with a lot of meds you can use to augment.Low dose stims,most sedatives etc.Unless the old nardil comes back parnate is the only drug ill ever touch again.
>
> I have to admit I'm scared about MAOIs, their potential for hypertensive crisis and serotonin syndrome. Don't know how exaggerated my fears are.It doesn't hurt to have a healthy respect for the dangers associated with MAOI. You need to be vigilant in screening foods for a hypertensive reaction and medications for serotonin syndrome. I will say that it gets easier over time to live this way. The old diet is sometimes exaggerated.
- Scott
--------------------------------------------
Try Searching the Internet for "MAOI" "Diet".http://www.ncbi.nlm.nih.gov/pubmed/8889911
http://www.ccjm.org/content/77/12/859.full
"Absolute dietary restrictions include39:
Aged cheeses and meats
Banana peels
Broad bean (fava) pods
Spoiled meats
Marmite
Sauerkraut
Soybean products
Draft beers.
Among the many foods determined to be unnecessarily restricted are avocados; bananas; beef or chicken bouillon; chocolate; fresh and mild cheeses, eg, ricotta, cottage cheese, cream cheese, processed cheese slices; fresh meat, poultry, or fish; meat gravy (fresh); monosodium glutamate; peanuts; properly stored pickled or smoked fish (eg, herring); raspberries; and yeast extracts (except Marmite).39"
Posted by emmanuel98 on March 16, 2012, at 18:41:50
In reply to Re: MAOI » tensor, posted by SLS on March 16, 2012, at 6:03:21
I also found the old lists needlessly restrictive and found (maybe through one of Scott's link) a more reasonable approach. For one thing, the most recent thing I read said an ounce of cheese is not a problems. 2-3 ounces is. So I started adding a little parmesan to spaghetti, a little feta to salad. No problem Serotonin ayndrome is easy to avoid -- just don't take meds that increase serotonin. Your p-doc should be very aware of this. Pain meds are fine, except tramadol and demerol. If you have to have anesthesia, tell the doc about MAOIs in advance and the need to avoid demerol. Have been taking parnate for 2-1/2 years without a problem. Even occasionally have a slice of pepperoni pizza, since they only have a 1/2 ounce or so of pepperoni. I avoid red wine, draft beer, significant servings of dried meat or aged cheeses and use soy sauce only in tiny quantities when a friend insists on sushi.
Posted by tensor on March 17, 2012, at 8:39:35
In reply to Re: MAOI, posted by emmanuel98 on March 16, 2012, at 18:41:50
Posted by kagome on March 17, 2012, at 10:09:14
In reply to Re: MAOI, posted by emmanuel98 on March 16, 2012, at 18:41:50
> I also found the old lists needlessly restrictive and found (maybe through one of Scott's link) a more reasonable approach.
Same here, although I may have been overdoing the pepperoni pizza a bit... it's a main staple of my diet...
Anyway, I have a question:
Pain meds are fine, except tramadol and demerol. If you have to have anesthesia, tell the doc about MAOIs in advance and the need to avoid demerol.
So what do they use instead? I have to have surgery soon (oral surgery to remove a possibly lamictal-related tumor) and the Dr told me he was going to use demerol to knock me out. I told him I was on Parnate and he said it wasn't a problem. Obviously not true, but what should he be using instead?
Posted by SLS on March 17, 2012, at 12:30:29
In reply to Re: MAOI » emmanuel98, posted by kagome on March 17, 2012, at 10:09:14
> > I also found the old lists needlessly restrictive and found (maybe through one of Scott's link) a more reasonable approach.
>
> Same here, although I may have been overdoing the pepperoni pizza a bit... it's a main staple of my diet...
>
> Anyway, I have a question:
>
> Pain meds are fine, except tramadol and demerol. If you have to have anesthesia, tell the doc about MAOIs in advance and the need to avoid demerol.
>
> So what do they use instead? I have to have surgery soon (oral surgery to remove a possibly lamictal-related tumor) and the Dr told me he was going to use demerol to knock me out. I told him I was on Parnate and he said it wasn't a problem. Obviously not true, but what should he be using instead?
Indicatedpropofol
midazolam
ketorolac
morphine
ketamine
oxycodone
hydrocodone
phenelphrine
Contraindicated:meperidin
tramadol
norepinephrine
epinephrine
dextromethorphan
pancuronium
pethidine
Inconclusive:* fentanyl
sufentanil
alfentanil
remifentanil* I read recently than fentayl was okay to use in conjunction with MAOIs.
- Scott
Posted by Phillipa on March 17, 2012, at 20:30:33
In reply to Re: MAOI » emmanuel98, posted by kagome on March 17, 2012, at 10:09:14
Did you write lamictal related tumor? Lamictal gives you tumors? Seriously I didn't know this. Phillipa
Posted by kagome on March 18, 2012, at 20:57:37
In reply to Re: MAOI, posted by SLS on March 17, 2012, at 12:30:29
Thanks so much, Scott! Potentially life saving. I'll see what the doctor says.
-kagome
Posted by kagome on March 18, 2012, at 21:01:26
In reply to Re: MAOI » kagome, posted by Phillipa on March 17, 2012, at 20:30:33
> Did you write lamictal related tumor? Lamictal gives you tumors? Seriously I didn't know this. Phillipa
It could just be me, but Lamictal seems to have a bad combination of dehydration and leeching of calcium and magnesium that make some people's teeth fall out and for me it caused a tumor in the gums. Again, though I'm probably just weird. However I would definitely recommend that anyone taking lamictal supplement with Calcium and Magnesium, drink a lot of water, and get tons of dental check ups.
-kagome
Posted by jedi on March 23, 2012, at 22:40:55
In reply to Re: MAOI » emmanuel98, posted by kagome on March 17, 2012, at 10:09:14
Your story shows you why you have to take your education to a new level when using MAOIs. If a Dr. told me Demerol(meperidine) was fine with Parnate, I would run fast in the other direction. I have been on Nardil for most of 14 years. The food restrictions are way overblown. Certain medications like the ones Scott listed are definite No-Nos. Most over the counter cold medications are out also. They don't work anyway.
I don't wear an ID bracelet, but I probably should. It is written specifically on the back of my driver's license and in my cell phone. Taking MAOI - No meperidine.
Everybody is different. I've had two trials of Parnate and it never worked for me. I even had a rare auto-hypertensive episode on Parnate, so no more trials for me. Nardil has always worked. If your depression is atypical with social anxiety, Nardil might be the answer. It sometimes works when nothing else will.
Good Luck,
Jedi> So what do they use instead? I have to have surgery soon (oral surgery to remove a possibly lamictal-related tumor) and the Dr told me he was going to use demerol to knock me out. I told him I was on Parnate and he said it wasn't a problem. Obviously not true, but what should he be using instead?
This is the end of the thread.
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