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Re: Nardil "poop-out"--Parnate, too

Posted by Scott L. Schofield on January 22, 2000, at 9:52:34

In reply to Re: Nardil "poop-out"--Parnate, too, posted by Kim on January 22, 2000, at 6:01:36

Hi Kim.


> I was on Nardil for about a year, felt so good I quit taking it. When I crashed several months later, it didn't work.

See: http://www.dr-bob.org/babble/20000112/msgs/19064.html

> I've been on Parnate for 2 years now; but it's pooping out. The two MAOI's are the only ADs that have worked at all so far, so I'm feeling desperate about the Parnate quitting. Are there any other MAOI's out there?

In the United States, I believe that there are four MAOIs (Monoamine oxidase inhibitor) currently available, all of which are considered to be "irreversible". The term irreversible is used to describe the property of these drugs to stick to the MAO enzyme permanently (or nearly so), so that it can no longer perform its function of breaking-down an excess of neurotransmitter molecules. Elsewhere in the world, RIMAs (reversible inhibitors of monoamine oxidase) are available as antidepressants. Because they are reversible, it is generally accepted that there is no need to adhere to the dietary restrictions required for the irreversible ones.


Irreversible MAOIs

1. Nardil (phenelzine)
2. Parnate (tranylcypramine)
3. Marplan (isocarboxazid)
4. Eldepryl (selegiline, l-deprenyl)


Reversible MAOIs

1. moclobemide
2. brofaromine

- Other RIMAs are pretty far along in the approval process in Europe, however, I haven't looked into whether any are being looked at for marketing in the U.S.


In your case, I think it makes sense to add another drug (augment) to the Parnate. There's are lots to choose from. They can be *very* effective, however, I don't think the majority of psychiatrists would feel comfortable with many of these.


Possible augmenting agents (off the top of my head):

1. Wellbutrin
2. Cylert
3. Amphetamine
4. Tricyclics
5. Lithium
6. Pindolol
7. Ritalin
8. Zyprexa
9. Thyroid hormone
10. Psychotherapy


*** NOT: SSRIs (Prozac, Zoloft, Paxil, Celexa, Luvox) or Effexor (which also blocks the reuptake of serotonin).


I know how hard it is to make these decisions. I often second-guess my own choice and those of my doctor. "Just get it right the first time".

I have received partial releif from a combination of Parnate and Norpramin (desipramine).

Good luck.


- Scott


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poster:Scott L. Schofield thread:19201
URL: http://www.dr-bob.org/babble/20000112/msgs/19398.html