Posted by SLS on June 28, 2000, at 17:36:45
In reply to Re: MAOI Diet Restrictions, posted by janeS on June 28, 2000, at 12:36:26
Hi Jane.
Marplan (isocarboxezid) is an MAO inhibitor that is more similar to Nardil than it is to Parnate. I have seen people respond very well to Marplan that had not responded at all to Nardil.
What side effects in particular is your doctor concerned about?
What was your experience with Tofranil? Why did you discontinue it?
I guess it makes sense to select first those antidepressants that produce the least side effects. However, if one has already tried these without success, it makes sense to then try other drugs despite their liability to produce acceptable side effects. Now, if these drugs don't work, I think it makes a great deal of sense to try those drugs that already have. This seems logical to me.
Perhaps your doctor is not comfortable with using MAOIs and tricyclics because he has little experience with them. Tofranil (imipramine) is still the gold-standard by which all other antidepressants are compared for efficacy. You are already familiar with how this drug affects you, so I don't understand why a doctor would tell you that the side effects of Tofranil are unacceptable if you have expressed a desire to return to it. Desipramine (Norpramin) is also a tricyclic. In fact, it is the compound that Tofranil turns into when the body begins to break it down. Although desipramine can produce the same kinds of side effects as Tofranil, they are milder. The major concern with using tricyclics is that they can affect the heart. This is usually not a problem, but if your doctor is uncomfortable using these drugs, having an EKG would not be a bad idea.
I think it makes sense to explore a few drug combination strategies since you are not planning to go back to Nardil right away. One paper I read emphasized the effectiveness of combining Remeron with Effexor. Effexor plus Wellbutrin is another combination that I know can be effective when neither by itself is adequate. I think combining drugs that have already shown themselves to be partially effective is a good strategy. If Remeron helps, you may want to build combinations around it.
If you need to get radical, yet remain safe, you can combine an MAO inhibitor with a tricyclic. I mention this because you have had success with both. I have taken Nardil and desipramine together, but responded only minimally. When combined, I experienced more postural hypotension (low blood pressure upon standing) and had trouble initiating urination. There is some thought that the tricyclic can actually provide a buffer against a tyramine (cheese) reaction. The only drug regimen that ever worked for me was a combination of Parnate and desipramine. Unfortunately, my doctor at the time had me discontinue this treatment in favor of Prozac, which had just been approved. It didn't work. When it finally came time to try the combination again, I failed to respond to it. Here I am.
Good luck. Please post.
* Does anyone know if Remeron can be combined with an MAO inhibitor safely?
- Scott
poster:SLS
thread:38324
URL: http://www.dr-bob.org/babble/20000619/msgs/38600.html