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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 4 of 4. This is the beginning of the thread.
Posted by David G on May 1, 2008, at 13:04:59
Been on Welburtrin (4 years) and Lamictol (1 year) but feel the need to try a different path. I have aspergers with bipolar and the meds keep me from getting depressed. But then again I don't feel much of anything now and I'm tired of it. I also have Chronic Fatigue (poz for EB virus) - I don't get pain but I do get malaise both mentally and physically.
My doc and I have discussed MAOI's as an alternative. I need to keep my energy up (if normal is a 10 and coma is 0, I'm about 6-7 on a good day). I've reviewed the standard lit out there about drug and food interactions and the generalized side effects. I have a few questions though:
1) Has anyone tried a patch and if so, what did you think?
2) What kind of antihistamine do you take if you have a cold/flu? Any problems with anti-biotics?
3) I've seen mention of intestinal problems but is that really from the drug or is that from (unknowingly) eating things from the Do Not Eat list? I've also seen contradictions regarding if fish can be eaten or not.
4) If you have tried different MAOI's, which ones did you like or not? Why?
5) I've seen reference to MAOI's increasing respiration infections like bronchitus and sinusitus? Anyone have input on that?Thanks!
Posted by Quintal on May 1, 2008, at 13:31:57
In reply to Considering an MAOI, posted by David G on May 1, 2008, at 13:04:59
> 1) Has anyone tried a patch and if so, what did you think?
No. I've only tried selegiline tablets and they made me agitated and irritable.
> 2) What kind of antihistamine do you take if you have a cold/flu?
You don't need to take an antihistamine if you get cold or flu, but plain Benadryl (diphenhydramine) is safe to take with MAOIs.
>Any problems with anti-biotics?
Not with common antibiotics, but isoniazid would be a problem.
> 3) I've seen mention of intestinal problems but is that really from the drug or is that from (unknowingly) eating things from the Do Not Eat list? I've also seen contradictions regarding if fish can be eaten or not.
What intestinal problems have you read about? Eating tyramine-rich foods is more likely to affect your blood pressure than your guts. Fresh fish is safe, but the sauce it comes with/is marinaded in might not be.
> 4) If you have tried different MAOI's, which ones did you like or not? Why?
Parnate was the only one I liked, in fact it was the best antidepressant I've ever taken. Marplan was okay side-effect wise, but didn't do a great deal for my depression or anxiety. Moclobemide was usless.
> 5) I've seen reference to MAOI's increasing respiration infections like bronchitus and sinusitus? Anyone have input on that?
I don't think it's a particular problem among MAOI users. I wouldn't worry about it
Q
Posted by octothorpe on May 1, 2008, at 16:39:31
In reply to Considering an MAOI, posted by David G on May 1, 2008, at 13:04:59
Hi David. Here is my experience:
>
> 1) Has anyone tried a patch and if so, what did you think?Have tried it. It was energizing but too anxiety provoking for me. It might be the best MAOI to try first, since at the lowest dose you do not need to follow the low tyramine diet.
> 2) What kind of antihistamine do you take if you have a cold/flu? Any problems with anti-biotics?
Stay away from anything with Dextromethorphan (commonly labeled "DM"). MAOI Warnings are pretty good (and abundant) on over the counter cold medicine. For congestion you can take Guaifenesin (just not "DM"). I haven't had to take any antibiotics, and don't usually take anything for cold/flu.
> 3) I've seen mention of intestinal problems but is that really from the drug or is that from (unknowingly) eating things from the Do Not Eat list? I've also seen contradictions regarding if fish can be eaten or not.
No intestinal problems other than gas, :( SE from the med. Other than the lowest dose of Emsam, you need to watch the diet, but it's not hard.
Fresh fish is fine, including canned tuna (eat within 48 hours after opening). Stay away from anything pickled, aged or smoked.
> 4) If you have tried different MAOI's, which ones did you like or not? Why?
I've tried parnate, emsam, and nardil, which I am currently on. They say parnate is energizing... it gave me severe hypotension and made me sleepy, but it helped some. Emsam, too much anxiety so I couldn't continue. Nardil, sleepiness in the afternoon but I've had *incredible* *incredible* relief from depression and anxiety. That is after an untold number of meds over the past 30 years.
> 5) I've seen reference to MAOI's increasing respiration infections like bronchitus and sinusitus? Anyone have input on that?
No such issues with me.
Your mileage may vary, etc... :)>
> Thanks!
Posted by undopaminergic on May 2, 2008, at 15:40:02
In reply to Re: Considering an MAOI, posted by Quintal on May 1, 2008, at 13:31:57
The selegiline patch (EMSAM) is a suitable first choice of a MAOI. Tranylcypromine (Parnate) is a suitable next choice, as it has a lower risk of causing weight gain, sedation, and elevated liver enzymes than the other classic MAOIs. Isocarboxazid (Marplan) is reputedly less likely to produce weight gains than phenelzine (Nardil). However, Nardil may be superior for anxiety.
> > 2) What kind of antihistamine do you take if you have a cold/flu?
>
> You don't need to take an antihistamine if you get cold or flu, but plain Benadryl (diphenhydramine) is safe to take with MAOIs.
>All antihistamines except chlorpheniramine and brompheniramine are safe. However, the cough-suppressant dextromethorphan is best avoided while on MAOIs, due to the risk of serotonin toxicity, and so is the use of indirectly acting adrenergic agonists such as the nasal decongestant pseudoephedrine, as they can elicit strong hypertensive reactions.
> >Any problems with anti-biotics?
>
> Not with common antibiotics, but isoniazid would be a problem.
>Linezolid would also be problematic, as it is a MAOI itself.
This is the end of the thread.
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