![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by UgottaHaveHOPE on April 23, 2006, at 12:04:16
I dont understand it. They act like it's poison or something. How do you convince them to let you try one?
And which one should I try to anxiety?
Posted by ed_uk on April 23, 2006, at 12:25:43
In reply to Why are US pdocs so hesitant to prescribe MAOI?, posted by UgottaHaveHOPE on April 23, 2006, at 12:04:16
MAOIs are not easy to prescribe. A knowledgeable psychiatrist is needed to educate the patient. It's a time consuming process, very difficult in a world of 5 minute 'med checks'. Most pdocs don't know much about MAOIs, and are, as a result, ill-equipped to prescribe them.
Ed
Posted by Klavot on April 23, 2006, at 14:50:31
In reply to Re: Why are US pdocs so hesitant to prescribe MAOI? » UgottaHaveHOPE, posted by ed_uk on April 23, 2006, at 12:25:43
My psychiatrist told me she has only two of her patients on MAOI's and that she doesn't like them because of the implications if one needs non-elective emergency surgery.
Posted by Crazy Horse on April 23, 2006, at 16:12:48
In reply to Re: Why are US pdocs so hesitant to prescribe MAOI?, posted by Klavot on April 23, 2006, at 14:50:31
> My psychiatrist told me she has only two of her patients on MAOI's and that she doesn't like them because of the implications if one needs non-elective emergency surgery.
Truth is, a good anesthesioligist has no problem with maoi patients. Many Doctor's are just so deficient of knowledge when it comes to maoi's. Mine included. I think they just don't want the "hassle" of an maoi. So much easier to hand out the Prozacs, and zolofts, etc. and say see ya in a month. It's really a shame because maoi's are powerful ad's and that is exactly what many people need.
CH
Posted by ed_uk on April 23, 2006, at 16:52:16
In reply to Re: Why are US pdocs so hesitant to prescribe MAOI? » Klavot, posted by Crazy Horse on April 23, 2006, at 16:12:48
The majority of drugs used in anesthesia don't interact with MAOIs. Avoiding the drugs which do interact (eg. Demerol) is easy. All you really need is a good anesthetist.
Ed
Posted by jedi on April 23, 2006, at 17:04:57
In reply to Why are US pdocs so hesitant to prescribe MAOI?, posted by UgottaHaveHOPE on April 23, 2006, at 12:04:16
> I dont understand it. They act like it's poison or something. How do you convince them to let you try one?
>
> And which one should I try to anxiety?Hi,
Part of the reason is the need for pretty radical tort reform in the US. Medical malpractice insurance already drives some good people out of the field. If I screw up and kill myself with a MAOI, my family could sue the MD. I believe that patients who take MAOIs need to take a lot of the responsibility for the danger upon themselves. I have taken Nardil for the better part of ten years and have had some PDOCs that have just outright refused to prescribe a MAOI. Since Nardil is the only med that works for my major atypical depression, I have had to shop for a MD to prescribe it several times in my life. I provide the MD with the studies which show that a MAOI is sometimes the only thing that works for atypical depression. I give him plenty of things in writing showing that I'm a knowledgeable patient that isn't going to go out and eat a half pound of cheddar cheese.This shopping for doctors is very difficult when you are in serious depression, but sometimes must be done just to survive. I have experienced exactly what you are talking about. When you know a medication will work and you can't get it prescribed, it feels like you are in a no win battle against the world. Go to the doctor with reviewed scientific studies, not anecdotal evidence like we see here on Babble. Use the information gained here to find the actual studies which show the meds work. Even then some doctors are so ego centered that they won't look at any information provided by a patient. In that case, you just have to move on to the next MD on the list.
In my opinion, Nardil is the best medication for social anxiety. It is even better when mixed with a small dose of clonazepam.
Good luck,
Jedi
Posted by Crazy Horse on April 23, 2006, at 18:28:01
In reply to Re: Why are US pdocs so hesitant to prescribe MAOI? » Crazy Horse, posted by ed_uk on April 23, 2006, at 16:52:16
> The majority of drugs used in anesthesia don't interact with MAOIs. Avoiding the drugs which do interact (eg. Demerol) is easy. All you really need is a good anesthetist.
>
> EdThe only reason i knew the above was because of you Ed. Ed the Educator! :)
Monte
Posted by Phillipa on April 23, 2006, at 21:55:22
In reply to Re: Why are US pdocs so hesitant to prescribe MAOI? » ed_uk, posted by Crazy Horse on April 23, 2006, at 18:28:01
Monte I was here first. Ed is mine I'm very possessive.!!!!!!!Love Jan
Posted by Crazy Horse on April 23, 2006, at 22:24:45
In reply to Re: Why are US pdocs so hesitant to prescribe MAOI? » Crazy Horse, posted by Phillipa on April 23, 2006, at 21:55:22
> Monte I was here first. Ed is mine I'm very possessive.!!!!!!!Love Jan
No problem..ha ha ha :)
Posted by med_empowered on April 24, 2006, at 6:28:19
In reply to Re: Why are US pdocs so hesitant to prescribe MAOI? » Crazy Horse, posted by Phillipa on April 23, 2006, at 21:55:22
I don't really believe in tort reform (the problem is really the insurance companies and incompetent docs who pop up now and then, not everyday patients), but I do think pdocs need to take a deep breath, calm down, and stop thinking about liability or..whatever, and start doing what's best for their patients. They are, after all, doctors who supposedly specialize in this stuff--they really should act like it.
Anyway--MAOIs are a pain, and they have gone in and out of fashion. For a while, docs thought they weren't much better than placebo, b/c of some poorly designed studies with too low doses. Then some docs went crazy with them--MAOIS plus TCAs (and stims), MAOIs plus phenothiazines, so on and so forth. SSRIs are much easier to handle, and even the TCAs are more appealing when compared to the kind of patient management (eg, "work") required to manage MAOI usage. Plus...docs these days are obssesed with antipsychotics, SNRIs, and mood stabilizers (b/c apparently everyone is bipolar). With EMSAM now on the market, I think the pill form of other MAOIs may see a bit of a rise in popularity, possibly starting a new "trend" in RXing. Or not.
Posted by greywolf on April 24, 2006, at 8:11:21
In reply to Re: Why are US pdocs so hesitant to prescribe MAOI, posted by med_empowered on April 24, 2006, at 6:28:19
>>Plus...docs these days are obssesed with antipsychotics, SNRIs, and mood stabilizers (b/c apparently everyone is bipolar).
Depends on who you talk to. Most docs I know would go with an MAOI before they started on the atypical APs for treatment of depression, partly due to difficulties with insurance companies not wanting to pay for high atypical costs.
Additionally, from my own non-scientific and limited personal perspective, it seems that fewer people are being diagnosed with BP in the last few years, and that more people are getting the unipolar or cyclothemic tag. Of course, that's my opinion only, and I could be wrong.
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.