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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by crazyvash on September 12, 2015, at 22:18:49
As an introduction, my current diagnosis is bipolar II. Which, like most people with the condition, I suffer from mostly the depression aspect. Fortunately, my hypomania and mixed states are under control with a combination of Lamictal and Seroquel. Although, when it comes to the depression, relief from that still alludes me. Unfortunately for me, the only antidepressants that work are the MAOI's. Granted, I am thrilled that something works at all, but the combined hypotension from the Seroquel, and currently EMSAM are making things very difficult. I have already tried switching the Seroquel around with various antipsychotics, but then I run into the situation of either the drug doesn't do the job (Risperdal, Abilify, Loxitane), or I run into hypotension problems again. (Saphris) I could try replacing the EMSAM with something like Nardil or Parnate, but according to my doctor, EMSAM is a little better with hypotension than the other two are. Also, having done this medication dance for a long time now, I am just getting tired of playing whack-a-mole. I have read before that taking salt tablets and/or fludrocortisone can help with this. I have mentioned this to my doctor, as he was unaware of this, so hopefully I'll have a way to "fix" this problem. I guess I'll find out what we'll try at the next appointment. If anyone has any similar experiences, I'd appreciate any information or suggestions.
Now why the subject title of moclobemide? Well, from my research, moclobemide doesn't have the issues with hypotension as much as the traditional MAOI's, so that's why I am interested. Also, if the salt tablets/fludrocortisone idea doesn't work, at least I have an alternative plan that I am working on.
Other than going to Canada and getting a prescription in that fashion, I have another question. Can a doctor from the United States legally write a prescription for an unapproved drug like moclobemide to have it filled at a foreign (Canada) mail order pharmacy? A recent phone conversation with my current doctor basically came down to that if I wanted the drug, then I'll have to go out of the country to get it. I am guessing he said this because he is on the careful side, but then again, maybe legally he can't do it even if he wanted to. I'll make sure to properly grill him next time. I have read about people that have supposedly gotten this medication who are U.S. citizens, so I am curious about how they went about this.
In the end, I guess I am looking for anyone that has gone through this issue of hypotension and any experiences that they have had with treating it. Worst case scenario, if I have to go to Canada to try out moclobemide, then so be it, but I would rather not.
Thanks.
Posted by chumbawumba on September 12, 2015, at 23:41:19
In reply to Hypotension, MAOI's, and Moclobemide, posted by crazyvash on September 12, 2015, at 22:18:49
Yes a Doctor in the United States can prescribe it and you can get it filled by mail order from Canada. I have been doing that for the last two years. My first Doctor wouldn't do it though so I had to find another Doctor who would. I also never experienced hypotension from moclobemide.
Posted by SLS on September 13, 2015, at 6:25:56
In reply to Hypotension, MAOI's, and Moclobemide, posted by crazyvash on September 12, 2015, at 22:18:49
I believe that:
1. Moclobemide poops-out 90 percent of the time, leading to a constant escalation in dosage to 1200 mg/day without continued relief.
2. Moclobemide binds to MAO-A very tightly, even though it dissociates. One still needs to pay attention to the intake of tyramine. No more than 50 mg of tyramine should be consumed at one meal.
3. Moclobemide can make depression worse, although this does not occur in a great percentage of people. In this way, it really is no different from other antidepressants.
4. If moclobemide does work for you, it usually does not produce sexual side effects or weight gain.
5. I am not aware of hypotension being a problem with moclobemide in the majority of cases. It might be, but I am just not aware of it. I experienced no dizziness at all.
Have you tried Abilify, Saphris, or Geodon? Despite the indication of Seroquel for bipolar depression, I have never seen it work robustly or for very long.
You might want to explore a treatment regime similar to:
- Trileptal for the hypomania / mixed-state.
- Lamictal for the depression.
- Abilify, Geodon, or Saphris for residual depression and perhaps more protection against mania.Of course, you would want to work closely with your doctor on this, but I don't see any contraindications for this combination.
* Despite many years of trying, Roche was unable to get the U.S. FDA to approve moclobemide. Roche even tried to get it approved for social anxiety instead. It didn't work in clinical trials, so Roche abandoned the project.
- Scott
Posted by SLS on September 13, 2015, at 15:47:56
In reply to Re: Hypotension, MAOI's, and Moclobemide » crazyvash, posted by SLS on September 13, 2015, at 6:25:56
Oops.
Interaction:
Trileptal can accelerate the metabolism of Geodon. You can take Geodon, but you might need more of it to get the desired effect.
- Scott
Posted by baseball55 on September 13, 2015, at 19:45:24
In reply to Oops: Hypotension, MAOI's, and Moclobemide, posted by SLS on September 13, 2015, at 15:47:56
I wonder if you could just learn to live with the postural hypotension? I did on parnate. I was careful getting up out of bed or out of a chair. I would stand still and hang on to something for a minute or so until I felt stable. It stinks, but if the MAOI is working, it seemed to me well worth it.
Posted by chumbawumba on September 14, 2015, at 1:21:21
In reply to Re: Hypotension, MAOI's, and Moclobemide » crazyvash, posted by SLS on September 13, 2015, at 6:25:56
> I believe that:
>
> 1. Moclobemide poops-out 90 percent of the time, leading to a constant escalation in dosage to 1200 mg/day without continued relief.
>
This was my experience
>
>
> 4. If moclobemide does work for you, it usually does not produce sexual side effects or weight gain.
>
This was also my experience.Great medication, when it worked. Now I'm on Parnate, It's been a week at 20 mg and I already feel a lot better.
Posted by SLS on September 14, 2015, at 2:06:46
In reply to Re: Hypotension, MAOI's, and Moclobemide, posted by chumbawumba on September 14, 2015, at 1:21:21
> > I believe that:
> >
> > 1. Moclobemide poops-out 90 percent of the time, leading to a constant escalation in dosage to 1200 mg/day without continued relief.
> >
> This was my experience
> >
> >
> > 4. If moclobemide does work for you, it usually does not produce sexual side effects or weight gain.> This was also my experience.
>
> Great medication, when it worked. Now I'm on Parnate, It's been a week at 20 mg and I already feel a lot better.Don't forget that Parnate has some amphetamine-like properties. The effects feel pretty good in the beginning, but can wear off quickly. This is usually not the true antidepressant effect, though. That might take a month or more to develop, especially when titrating gradually. Also, most people need a minimum of 40 mg/day. I would say that the range should be between 40 - 80 mg/day. Some people respond only to high-dose therapy; 120 mg/day or more. Although I have heard of people taking 300 mg/day, I have seen studies use a maximum dosage of only 170 mg/day (Jay Amsterdam).
I hope that you have better luck with Parnate than you did with moclobemide.
- Scott
Posted by Lamdage22 on September 15, 2015, at 7:03:01
In reply to Re: Hypotension, MAOI's, and Moclobemide » chumbawumba, posted by SLS on September 14, 2015, at 2:06:46
For me, on Nardil, which is worse in terms of hypotension, the (postural) hypotension disappeared after two or three months.
In the meantime, i drank a glass of salt water before i got up in the morning.
This is the end of the thread.
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