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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 EdithAnn on December 2, 1999, at 20:50:07
Having gone down the path of SSRI's (Prozac, Zoloft, Celexa, Wellbutrin and various combo's) I'm considering MAOI's. Wondered what sort of success people have had with them? how big a pain in the neck is the diet? how dangerous it is if I dork up and eat a prohibited food? (I read something about an "antidote" of some sort that you can get a script for) and of course, the age old question...are there sexual problems? why do MAOI's seem to be the drug of last resort?
Posted by JohnB on December 2, 1999, at 22:48:25
In reply to Considering MAOI's, posted by EdithAnn on December 2, 1999, at 20:50:07
EdithAnn,
Hi. Please see my post directly up above. I've tried Nardil, Parnate, Marplan, and Selegiline - all MAO inhibitors.
Regarding the dietary issues, which I think are the only concerns of yours which I didn't address in my post above, let me share my experiences with you. I have found that, FOR ME, the dietary concern was overblown. I was initially concerned about giving up all cheeses, all forms of liquor, and just about everything else in my life. Almost everything seems to be contraindicated. What I have found is that I need to avoid the aged types of products, and have very limited quantities of those which have more than minimal tyramine content. For example, I eat pizza like crazy, along with grilled cheese sandwiches. So, mozzarella, cheddar, and colby cheese doesn't bother me. I stay away from the aged cheeses, such as blue cheese, etc. I drink beer, only usually lite beer or regular beer - no dark. I also drink white wine, but avoid red wine like the plague. Even a little bit of red wine can give me a headache, though I've never had a real hypertensive crisis - head pounding, neck stiffening,etc. I eat bananas, but just the slightly green to yellow type. I always thought the brown ones were horrible, and they're supposed to be high in tyramine as well. Let's see . . . . I also avoid cold medications containing the ingredients which are contraindicated, which exludes almost all cold medication. Further, you need to let your dentist and general practitioner know your taking an MAOI, so you can avoid any interactions with anesthesia or other medications. Further, it has been suggested that people taking MAOI's wear an identification bracelet or other type of ID indicating they're taking an MAOI, in case they were to be in an accident, taking to an emergency room, and receive treatment before they're able to tell anyone they're taking an MAOI. Again, reactions to certain types of anesthesia and other drugs can be very, very serious.
One last item - regarding an antidote for hypertensive crisis. Yes, my doctor prescribed a medication for me to take if I were to experience symptoms. However, he did this only when he was very cautiously combining Bupropion with Parnate, which is contraindicated in the drug literature.
Hope this helps.
JohnB
Posted by JIM on December 2, 1999, at 23:02:30
In reply to Re: Considering MAOI's, posted by JohnB on December 2, 1999, at 22:48:25
> EdithAnn,
>
> Hi. Please see my post directly up above. I've tried Nardil, Parnate, Marplan, and Selegiline - all MAO inhibitors.
>
> Regarding the dietary issues, which I think are the only concerns of yours which I didn't address in my post above, let me share my experiences with you. I have found that, FOR ME, the dietary concern was overblown. I was initially concerned about giving up all cheeses, all forms of liquor, and just about everything else in my life. Almost everything seems to be contraindicated. What I have found is that I need to avoid the aged types of products, and have very limited quantities of those which have more than minimal tyramine content. For example, I eat pizza like crazy, along with grilled cheese sandwiches. So, mozzarella, cheddar, and colby cheese doesn't bother me. I stay away from the aged cheeses, such as blue cheese, etc. I drink beer, only usually lite beer or regular beer - no dark. I also drink white wine, but avoid red wine like the plague. Even a little bit of red wine can give me a headache, though I've never had a real hypertensive crisis - head pounding, neck stiffening,etc. I eat bananas, but just the slightly green to yellow type. I always thought the brown ones were horrible, and they're supposed to be high in tyramine as well. Let's see . . . . I also avoid cold medications containing the ingredients which are contraindicated, which exludes almost all cold medication. Further, you need to let your dentist and general practitioner know your taking an MAOI, so you can avoid any interactions with anesthesia or other medications. Further, it has been suggested that people taking MAOI's wear an identification bracelet or other type of ID indicating they're taking an MAOI, in case they were to be in an accident, taking to an emergency room, and receive treatment before they're able to tell anyone they're taking an MAOI. Again, reactions to certain types of anesthesia and other drugs can be very, very serious.
>
> One last item - regarding an antidote for hypertensive crisis. Yes, my doctor prescribed a medication for me to take if I were to experience symptoms. However, he did this only when he was very cautiously combining Bupropion with Parnate, which is contraindicated in the drug literature.
>
> Hope this helps.
>
> JohnB
>
> I wonder if it is safe to stop parnate(10mg. per day) after only a few weeks and restart Nardil immediately????
Posted by Adam on December 3, 1999, at 10:26:23
In reply to Considering MAOI's, posted by EdithAnn on December 2, 1999, at 20:50:07
I have also had disappointing experiences with all other antidepressants that I have tried,
and the only breakthrough for me (though far from perfect) has been an MAOI.My feeling is, if you're going to have to deal with side effects (and they can be borne),
you may as well take something that works. For some who do respond to MAOIs, the results
can be quite dramatic.The three doctors I spoke to either in the hospital or since I got out all thought the
dietary concerns were overblown for the average person, and that even if you do flub up
and eat the wrong thing, you may only experience a headache, some nausea, and a stiff
neck. However, all recommended that it was not advisable to wait for a hypertensive
crisis to resolve without getting some medical supervision. I guess this means going
to an emergency room (expensive!).I've seen many posts on this board that have suprised me; people seem to be eating all
kinds of things that I once thought were simply out of the question before. I think the
safest approach is to use caution, but do some research, and very carefully experiment.
A nibble of gorgonzola might not be a problem, but half a pound certainly would (the
"cheese effect" is dose dependant.) I think doctors' hands are a bit tied on this issue.
It is better for them, and of course, for us, if they are overly cautious and mistaken
than the alternative. And, also, one person may be able to eat almost anything, while
another may be very sensitive.I personally, am going to experiment a little, and keep $50 in my wallet for the ER.
> Having gone down the path of SSRI's (Prozac, Zoloft, Celexa, Wellbutrin and various combo's) I'm considering MAOI's. Wondered what sort of success people have had with them? how big a pain in the neck is the diet? how dangerous it is if I dork up and eat a prohibited food? (I read something about an "antidote" of some sort that you can get a script for) and of course, the age old question...are there sexual problems? why do MAOI's seem to be the drug of last resort?
Posted by saint james on December 3, 1999, at 11:06:52
In reply to Considering MAOI's, posted by EdithAnn on December 2, 1999, at 20:50:07
> Having gone down the path of SSRI's (Prozac, Zoloft, Celexa, Wellbutrin and various combo's) I'm considering MAOI's. Wondered what sort of success people have had with them?
James here....
You might try meds that effect nor-e such as TCA's, MAOI's and Effexor. Dirty meds like TCA's and MAOI's often work better than clean SSRI's. In England the MAOI's are considered first line treatment, even with the advent of SSRI's, so people can take these meds w/o incident. However,
no matter how many people say they have little or no problem with diet, be advised that one significant hypertensive event can solve all your problems. No more depression, diets to worry about, or life.In terms of risk, TCA's and Effexor are safer. Have you tried augmenting thyroid ? Pinodol ?
TCA + SSRI or SNRI. or naltraxolone + AD's ?james
Posted by JohnL on December 3, 1999, at 14:22:00
In reply to Re: Considering MAOI's, posted by saint james on December 3, 1999, at 11:06:52
I have no experience with the real MAOIs (just Moclobemide). And they aren't in my near future. But I'm just curious. I love chocolate. Gotta have it everyday. Can folks on MAOIs eat chocolate???
Posted by Mark on December 3, 1999, at 18:43:57
In reply to Re: Considering MAOI's, posted by JohnL on December 3, 1999, at 14:22:00
I have been on various first-line and second-line meds for social phobia for almost a year now, and nothing seems to work. I brought up the idea of an MAOI to my doctor and he refuses to porescribe it, and says that I should continue working with the Zoloft and BuSpar that I'm on even though its not working. I would switch docs in a second, but I have been with this one for a while and am worried that it will take me too long to build a working relationship with a new doc. I want some relief now. What are my options? Has anyone tried ordering medications from Mexico, where you dont need a prescription for many pharmacies
Posted by S. Suggs on December 3, 1999, at 19:47:45
In reply to Re: Considering MAOI's, posted by Mark on December 3, 1999, at 18:43:57
Mark, I would suggest that you search these archives and listed links to arm yourself with as much information to talk to your doc. Give him as much hardcopy info as possible. He is probably concerned about his malpractice insurance. MAOI'S are listed as a potential problem (based on PDR drug-drug / food interactions-due in part to manufactures filing for FDA approval) and he wants to avoid any legal issues. The manufacture of the drug and the prescribing physician are trying to avoid one place...a courtroom. Zoloft and Buspar are great meds, but I'd try the above aproach or another doc first.
Blessings,
S. Suggs
Posted by Zeke on December 6, 1999, at 9:29:09
In reply to Re: Considering MAOI's, posted by S. Suggs on December 3, 1999, at 19:47:45
Mark,
I hear and understand your frustration, but if you're not finding relief and can't work with this doctor, move on. If you must stay with him then ask for a 2nd opinion on treatment options (and if he can't deal with that you move on immediately). I appreciare what S said and agree that we should do some homework but my gut feeling is that the doc should be doing his homework too and you are likely to stir some resentment in him. By him saying "stay with what you're on," rather than freely discussing options, I'd think you'd just be challenging him (and his ego). Further, I wonder what kind of a valuable working relationship you've really developed over the past year.
I think many doctors tend to fall in love with certain medications and force everyone into rigid categories. This is from convenience, lack of experience or simply being inept. One the other hand many biologically oriented psychiatrists and neuropsychiatrists will take a much more agressive approach to treating you than you probably imagine. Indeed, much of the ground work has been done by your current doctor, and you can have your medical records forwarded to the new doc.
If you live near a university with a Med school, call the psychiatry school. Ask about faculty that specialize in social phobia or related disorders, or whether they have a specialty clinic for it. (Do this even for a second opinin -- an expert consult).
BTW, there are many options beyond MAOIs. Even changing from Zoloft to another SSRI (one will work when another doesn't) or another antidepressant or (as has beem suggested earlier) augmenting with Synthroid, pindilol, lithium or several other choices.
This is the end of the thread.
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