Posted by JohnL on October 9, 1999, at 16:43:11
In reply to Re: JohnL - MAOI?????, posted by dj on October 9, 1999, at 11:58:39
> JL,
>
> Why all the hype about the MAOIs. What's so great about them, in your opinion?????
>
> > It's not just my opinion any more, but the opinion of a prominent psychiatrist that indeed either a TCA or likely an MAOI is the preferred approach, with a possibility of very small dose lithium as well.
> >Hi dj. I'm sorry, I don't mean to sound like I'm hyping MAOIs. I've never even tried one, so I'm not one to speak from experience. Lori's case seemed especially troubling to me and I was trying to find suggestions that might hasten recovery. Since SSRIs have already been tried and failed, it would seem logical to me to try a different approach. And in this particular case, a big guns approach.
Hagop Akiskal, a prominent international psychiatrist, stated in his book 'Dysthymia and the Spectrum of Chronic Depressions' that one of the primary causes of AD failure is physicians' underuse of MAOIs. And it seems whatever I read or study, MAOIs often end up being the big guns that probably could have prevented a lot of suffering if tried earlier in treatment, rather than using them as a last resort. Hardly any GPs will prescribe them, and only about half of the psychiatrists use them. This is due to the fatal risk of eating improper diets and the risk of being sued for malpractice. Most ADs don't pose these risks and they usually work OK. But Dr Akiskal believes MAOI underuse is a primary reason for unnecesssary suffering.
Ivan Goldberg, another prominent psychiatrist, states that SSRIs no matter how high the dose are ineffective with certain types of depressions and that the TCAs and MAOIs often provide better results, though the side effect profile is more difficult to tolerate than SSRIs.
He also says it is hard to get excited about re-trying a drug that didn't provide good results initially. Lori's case has already been the SSRI route. Of course both of these psychiatrists seem to endorse lithium augmentation as a favored strategy as well. So MAOIs certianly aren't the only choice. I don't mean to sound like I'm hyping them. It's just that they are big guns. And they are a way to separate the feeble docs from the experts. Lori needs an expert.
And again, these are just my opinions. I'm no expert at all. My opinions are based on lots of literature as well as threads at this site going way back. In particular, these opinions are based on Akiskal's book and the 'Collected Writings of Ivan Goldberg', which can be found at www.execpc.com/~corbeau/. Heck, the more I read, I wonder why I haven't tried an MAOI myself yet! :)
poster:JohnL
thread:12619
URL: http://www.dr-bob.org/babble/19991016/msgs/12906.html