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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by MARTY on March 23, 2006, at 6:07:49
I'd like to know what people think about risky augmentation strategy while taking a MAOI. (ie. MAOI + Buspar, MAOI + Wellbutrin)
I was on Nardil + Lamictal + Risperdal + Neurontin.
BUT YESTERDAY, with the consent of my YOUNG psychiatrist and my pharmacist, I've took a not so common combinaision..
I have added BUSPAR to my cocktail.As you probably all know it's described by almost every pertinent MAOI related literature as been a very dangerous / potentially lethal combinaison: because it could lead to a Serotoninergic Syndrome, which statiscally kills 11% of the time.
My objective is to combat the sexual side effects of the Nardil. But as oppose to SSRI, MAOI isn't as easy to match with one of the drugs that are known to help. They are mainly dopaminergics (ie. agonist D1-D2) like Wellbutrin and Dostinex(Cabergoline) or antagonists of the serotinin receptors 5-HT2A/B/C like Buspar and Periactin(cyproheptadine).
I must acknowledge that I am very frightened right now, for obvious reasons.
While swallowing this BusPar pill I really had the feeling that I was playing the Russian roulette. Am I paranoid or just plain stupid ? ...for one of the very few time of my life I feel more like the latter.Any toughts on this would be appreciate;
(feel free to BabbleMail me)
Wish me luck,
Marty
Posted by linkadge on March 23, 2006, at 8:58:33
In reply to Nardil_MAOI + Buspar = Danger or simply suicidal ?, posted by MARTY on March 23, 2006, at 6:07:49
I don't know why there would be an interaction. Buspar is a 5-ht1a agonist, it doesn't affect the metabolism of serotonin in any way.
I think that it is a mild alpha-2 antagonist which would enhance norepinephrine release. See what other people say, but I don't really see how it would interact.
Linkadge
Posted by JaclinHyde on March 23, 2006, at 13:59:58
In reply to Re: Nardil_MAOI + Buspar = Danger or simply suicidal ?, posted by linkadge on March 23, 2006, at 8:58:33
My sons doctor put him on Buspar years ago for anxiety. I told her how it never worked for me and she replied that yes, they had found that in adults Buspar doesn't seem to do much good while in kids it seems to work. But ymmv of course.
I too had always heard that Buspar and MAOI's were a no-no. I would do some heavy duty googling if I were you and research it as much as possible.
Good Luck!
JH
Posted by MARTY on March 23, 2006, at 15:48:44
In reply to Re: Nardil_MAOI + Buspar = Danger or simply suicidal ?, posted by JaclinHyde on March 23, 2006, at 13:59:58
Thank you both for your post.
Scroll down for my replies ..
---= Interesting PDoc chat about Sex.Side effect Antidotes =---
http://www.dr-bob.org/tips/split/SSRI-sexual-dysfunction.html
---= A partial list of Antidotes
There are many possibilities: Amantadine, Bethanechol, Bupropion, Buspirone, Cyproheptadine, Dextroamphetamine, Methyphenidate, Mirtazapine, Nefazodone, Neostigmine, Yohimbine. Results on each of these varies. A physician can check "Sexual Pharmacology: Fast Facts" by Robert Taylor Segraves, MD and Richard Balon, MD for dosage).
---=Linkage >> You are right on one point: Buspar isn't causing Serotoninergic Syndrome.
After redoing my homework on google I've found out that I've missed a very importance statement in the Nardil Pfizer doc .. it says clearly that the risk with BusPar is related to Hypertensive Crisis. PS: BusPar increase Serotonin when it agonize pre/post 5-HT1a; those receptors not only will they produce Serotonin but they will stimulate (I'm sure how) the totality of the Serotonergic systems. 5-HT1a is the only receptor to have this powerfull caracteristic.JaclinHyde >> I didn't know that. But what I know is that for 1 person that likes BusPar there are 5 persons that hated it. While I put my money on the 5 ones, I may continue to take BusPar (in the event I conclude that the benefit is worth the risk).
The reason is that I try to design a cocktail that will reduce very significally the sexual side effect of the Nardil (and Risperdal). In the literature that discuss the known 'antidotes' for S.Dysfonction caused by Antidepressant, Buspar is coming back very often.
There are 3 things to look for in a ADSDA (Antidepressant Sexual Dysorder Antidote):
Antagonisation of the infamous 5-HT2c receptors, dopamine receptors agonism, cholinergic agents.1* Have you ever try one of the Antidote for Antidepressant induced sexual disorder ?
2* If you would be in my place, would you try BusPar in trying to save your sexual life (and couple!?)
(Nardil + Buspar = faster, stronger hypertension)
Hope your well,
Marty
Posted by Phillipa on March 23, 2006, at 21:51:16
In reply to Re: Nardil_MAOI + Buspar = Hypertention++, posted by MARTY on March 23, 2006, at 15:48:44
Marty please be careful. Love phillipa
Posted by JaclinHyde on March 24, 2006, at 11:29:57
In reply to Re: Nardil_MAOI + Buspar = Hypertention++, posted by MARTY on March 23, 2006, at 15:48:44
> JaclinHyde >> I didn't know that. But what I know is that for 1 person that likes BusPar there are 5 persons that hated it. While I put my money on the 5 ones, I may continue to take BusPar (in the event I conclude that the benefit is worth the risk).
Just be very careful!
> 1* Have you ever try one of the Antidote for Antidepressant induced sexual disorder ?The only thing I ever tried and it wasn't for it's sexual side effect was DHEA. It made me want to have sex more but it also made my temper increase. That told me that I was getting too much testosterone (I am female, btw ;-) It's something you might try, it is something that every person male or female needs more of as they get older (or so I have read.)
> 2* If you would be in my place, would you try BusPar in trying to save your sexual life (and couple!?)
No I wouldn't and that is the truth. To me having a reduced sex drive is a more than fair trade off to having no panic attacks, no hypochondria and no depression. If I had any of those three back againn my sex drive would suffer also.
Let us know what you decide. :-)
JH
Posted by MARTY on March 24, 2006, at 14:50:49
In reply to Re: Nardil_MAOI + Buspar = Hypertention++, posted by JaclinHyde on March 24, 2006, at 11:29:57
I agree with you JaclinHyde; The side effects, even the sexual one, is a relatively small pay for saving our lifes. That said, if theres a way to have both my life and a normal sexual life.. that would be better no? the fact is there a way to work those side effects but on the MAOI it's much more difficult than with SSRI or Tricyclic.I didn't take a decision yet. I'm waiting to talk to my PDoc and the people at pfizer (maker of Nardil) to fully understand what is the potential problem with Buspar. The only literature I've found on the subject after hours of googling is this
-> Phenelzine should not be used in combination with buspirone HCl, since several cases of elevated blood pressure have been reported in patients taking MAO inhibitors who were then given buspirone HCl. <-
... and this is from the official drug monograph of Pfizer. To me, it's not very clear how I should interpret the potential problem.
* Does it mean that someone could have an hypertensive crisis right from the first time he takes Buspar with Nardil ?
* or it means that Buspar is sometime giving hypertension to some people and that it's not a good thing to happen with Nardil because it's even more easy to get an hypertensive crisis in case of an excess Thyramine ?
* Now that I've tried it at X dose and my blood pressure ain't move at all, does it mean that as long as I take the same Buspar dose I should be okay ?
* etc.. (yes there are even more possible way to interpret it)
Right now I've stopped it for as long as I don't how to interpret the warning. After that I'll be able to take an enlighted decision. That I'll come back here to share it with you. and since there is nothing more to read than the pfizer warning I think it would be a good thing to freeze the answer in the forum so the next one facing this decision would not google for hours for nothing :)Hope your all well,
Marty
Posted by Caedmon on March 25, 2006, at 14:02:38
In reply to Nardil_MAOI + Buspar = Danger or simply suicidal ?, posted by MARTY on March 23, 2006, at 6:07:49
I don't really know. I would be very cautious, although my guess is that it is theoretically possible.
Is there a reason for not utilizing one of the other agents you posted about first? (bupropion, cyproheptadine)
- C
Posted by MARTY on March 25, 2006, at 15:17:23
In reply to Re: Nardil_MAOI + Buspar = Danger or simply suicid, posted by Caedmon on March 25, 2006, at 14:02:38
> I don't really know. I would be very cautious, although my guess is that it is theoretically possible.
Yes it is. Both beside knowing that 'Something' had already happen to someone.. we don't know much. So it's kind of hard to decide if I'm willing to take the risk if I can't know if it's a small, big or suicidal kind of risk.
> Is there a reason for not utilizing one of the other agents you posted about first? (bupropion, cyproheptadine)
Well.. Buproprion isn't a thing I could take. As a person with anxiety disorders raising my dopamine will without a doubt increase my anxiety level. In fact I already tried Bupropion 2 times in the last 5 years and after 2 months started to be VERY anxious. Besides Bupropion is on the same 'dangerous interaction' list that Buspar is.
Now for cyproheptadine it's something I'm currently looking at. But I have 2 concerns; weight gain (cyproheptadine is something prescribe to people who need to gain weight) and the fact that it is a Serotonine antagonist.. meaning that is can play against my AD. But before I definitively put cyproheptadine aside I will first try to find a weight antidote and make some googling to further understand how cyproheptadine works; it may well be selective enough to only play on those 5-HT receptors (5-HT2a/c and 5-HT3) that is good to antagonisze without antagonizing the good one.
You've make me realize that even if I would know precisely what are the risks with Buspar, I would not be ready to take a decision. I should investigate further those others agent that could do the job without any risks firts..
So thank you for your comments :)
Hope your well --
Marty
This is the end of the thread.
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