Posted by peridown on January 11, 2006, at 19:03:56
In reply to Re: Is Parnate more dangerous than Nardil ???, posted by stillaventfound on January 3, 2006, at 17:54:14
I'm also interested in this question as I'm about to start on an MAOI. My doctor was going to have me take Nardil, but after seeing a more experienced doctor (I was possibly going to partake in his clinical study) I will be starting Parnate, hopefully Monday. There appears to be more side effects with Nardil, HOWEVER, this doctor did indicate that Parnate can have more hypotension side effects -- which can be more dangerous than the other side effects. This can also indicate more sensitivity to tyramine, which, paradoxically, means further danger of hypertension! (Basically, the blood pressure is more out of wack!) I did see this opinion mentioned other places (not sure where), but didn't find studies for substantiation.
In any case, this is the actual research information I have been able to find (not including case studies and such). Unfortunately I only have access to the abstracts (PubMed), if anyone can get the actual articles I'd appreciate it -- I can supply any details needed.
1. Summary: no difference: A double-blind study of the 2 medications with 77 inpatient severely depressed patients.
They were studying the efficacy, which they found comparable. They did state, however, "a substantial number of patients experienced severe side effects, mainly dizziness, agitation, and insomnia; the incidence was the same in both samples (21%)."
J Clin Psychiatry. 2004 Nov;65(11):1505-10
I would just note the following: (1)These were inpatients, so their blood pressures and diets were probably carefully monitored. (2) The study was not focused on side effects, and only notes "severe" ones in the abstract. (3) I do not have a side-by-side comparison of side effects.2. Summary: Nardil has far more side effects than Parnate.
(a) Study of side effects of Nardil vs. Parnate with 61 patients: 42 Nardil; 19 Parnate.
Avg side effects/patient: Nardil:2.98 & Parnate:1.84! (Or 3 vs almost 2 side effects likely per patient on Nardil vs. Parnate.)
There were also more severe side effects for Nardil (9/42=.21 Nardil vs. 2/19=.11 Parnate). However, I personally would consider the size of the study to be a problem. In this study the abstract included hypotension; again Nardil was more problematic but I consider the study size an issue. (Especially with only 19 patients on Parnate.) I do not know if it was double blind -- there is no indication it was, but I only have the abstract.
Prog Neuropsychopharmacol Biol Psychiatry. 1989;13(3-4):497-504(b) A review of 198 patients using psychiatric charts.
Here is most of the abstract:
Based on clinical experience and literature review, 14 side effects were selected for study because of serious medical risk or subjective discomfort great enough to require drug discontinuation. Significant differences in risk for major side effects, as well as distinctive side effect profiles for each drug, were found. More side effects occurred on phenelzine, but these tended not to lead to drug discontinuation more often than with tranylcypromine, nor were they accounted for by differences in age, sex, diagnosis, or duration of treatment.J Clin Psychopharmacol. 1984 Oct;4(5):270-8.
Note: I do not know how many different psychiatrists they used.
A second article discusses various side effects including "hypertensive reactions, severe orthostatic hypotension, hypomania, significant weight gain, sexual dysfunction, and a residual category of multiple side effects which together culminated in drug discontinuation. In this report, frequency of their occurrence for each drug, level of severity, relation to dose and treatment duration, and physician response at the time the side effect was recorded are described. In addition, procedures found useful in the clinical management of these side effects are discussed."
J Clin Psychopharmacol. 1985 Feb;5(1):2-9If anyone can get hold of these last two articles (the two-part series) I would really appreciate it. It appears most robust of the studies.
I hope this helps, and isn't too much info.
G
poster:peridown
thread:592724
URL: http://www.dr-bob.org/babble/20060108/msgs/598067.html