Posted by Sad Panda on October 13, 2004, at 23:02:13
In reply to Parnate, Morphine, and Trusting Joe Paramedic =), posted by utopizen on October 13, 2004, at 21:54:54
> > And I can't understand preferring ECT to MAOI's. While I am not completely anti-ECT, they are generally recommended for deep, long-lasting, dark bouts of depression, not for the chronic low-level of depression and motivation that seem to be my main problems. Definitely not worth taking the risk of permanent memory loss for.
> >
>
> While ECTs may produce some memory loss, MAOIs kill. I think memory loss is less of a risk than dying. I think memory is a little over-rated when we're preferring it to death. =)
>
> (ECTs can lead to fatalities, but this is currently like 1 in 10,000 or 1 in 1,000, can't remember which, and it's mainly due to anesthesia, which is similiar to having to undergo any operation where you go under).
>
> I encourage your success with Parnate or Nardil if they help you. I didn't know you had prior experience with it. More power to you! I just wrongly assumed you heard things solely from this board about it, but if a doc you're seeing is experienced in managing it, he'll prescribe you that med that you can take for emergency hypertensive crisis and help guide you on the proper use of it.
>
> That said, let's not demonize drug companies. If a drug company gives a misleading statement in their NDA, that could lead to the FDA rejecting their application entirely, resulting in billion dollar loses.
>
> I don't think Eli Lilly misleadingly claimed in the clinical trial they submitted to the FDA that a substantial number of patients reported signifigant relief within 1-2 weeks of the 60mg dose. They made it clear in this statement that full benefit from the drug came after 4-6 weeks at 60mg.
>
> I don't think that's a dubious claim, since they had controlled trials, they were comparing this against placebo, and it's well-established that any drug targetting NE is likely to have a more rapid onset of action-- as subtle and benign as a couple of weeks seem- than SSRIs alone.
>
> Universivally-used qualitative measurements were used to make these assessments. These weren't exactly designed by quacks. If the FDA doesn't feel design methods are at the same par as other studies they are reviewing, they can throw out the application entirely.
>
> So there IS indeed a profit motive involved here in ensuring that information ISN'T misleading-- if it is suspected otherwise, that would cost Lilly billions in lost revenue from a drug like Cymbalta. I know it sounds crazy, that companies profit from practicing sound methods and using credible studies, but that's the reality.
>
> Deamonizing these companies isn't constructive. If you were a doctor who worked for Lilly, and you knew you contributed to creating a drug that literally saved millions of lives and gave hopeless people the chance to find meaning in this world, would you want others dismissing you as some salaried sell-out, some Lilly lackey?
>
> We might not find help from these drugs. But a lot do. And we need to appreciate the drug developers who invent these medicines for that reason alone. We need to appreciate that, even if we're not being helped, we're grateful someone is. That's what makes us compassionate. That's what makes us human.
>
> I am glad that Parnate and Nardil is still available for you, and your doctor still resesearches it for you. I'm not brave enough to take it on myself, since my ADD requires me to take 60mg/day of Adderall or sometimes, when I switch, 50mg of Desoxyn/day.
>
> So Parnate's not even an option for me anyway-- ECT would be safer than entering an amphetamine+MAOI-induced hypertensive crisis.
>
> But I do think Cymbalta's worth a shot. I'm not telling or advising you to combine it with other meds at this time. That's up to your doc to determine. But the reality is is that by the time you've tried maximizing the dose of Cymbalta and giving it a fair shot, there will likely be reports on the field and perhaps in journals documenting the effects of augmentation therapies with Cymbalta. It's set to exceed a lot of AD's in sales, and with that comes more research into drug augmentation.
>
> I want nothing more than for you to find relief. If Parnate or Nardil does that for you, more power to you. My only concern was that it would burden you with a dietary restriction, since I'm a nice guy and don't want to see others burdened with such things. If you're brave enough to deal with that, I admire that a lot.
>
> But remember, I have tried every AD on the U.S. market except for Serzone at this point. And I remain convinced that Cymbalta is worth a trial for me, given its unique properties and apparent uniqueness even when compared to Effexor. Even different SSRIs can affect the same person in completely different ways in terms of response or the lackthereof.
>
> Never think you have little hope in anything-- Cymbalta does indeed have clinical evidence of working rapdily if you take at least 60mg within the first week and try it for a couple of months.
>
> Also, food is not the only problem with the MAOIs (when I told my Doc I was a vegan, he laughed and said, "Steve, that's not the only issue").
>
> It means you can never take a stimulant, unless your doc is super brave and you're super experimental and frankly I can't advise that, because you just can't predict what extent of hypertensive crisis that will cause no matter what doc you see. And the drug interactions-- you mentioned several mental illnesses- what if you wanted to take something to increase your drive, like Strattera? It's unlikely you'd be given the option.
>
> And things you and your doc aren't even beginning to worry about, but all of a sudden becomes a case report at some emergency room two years from now-- what if you get surgery, and the anesthesiologist overlooks that you're taking an MAOI? Or you get given Demerol or morphine from a paramedic on the street while you're passed out and can't talk?
>
> Do you want to bet your life on the idea that a paramedic will decipher your med braclet, check his palm pilot for MAOI drug interactions with Dilaudid, and not inject you with anything? We're not just talking about asking the waiter at some restaurant to hold the cheese here, we're talking about issues I barely can imagine occuring that can kill you.
>
> So yeah, if everything else failed, and I was left between Parnate and ECT, I'd say memory take a hike-- my life is more important than a few years of remembering when I felt hopeless and meaningless in this world.
>
> God, if only dietary restrictions were the primary reason why MAOIs are avoided. One could only dream, though.
>
> best of luck to you. I don't care how you treat yourself, I care that you are treated.
>
>You are comparing certainties to maybes. With ECT you are certainly giving yourself a little doseage of brain damage. With MAOIs you might have a hypertensive crisis or serotonin syndrome. Serotonin syndrome is just as likely to occur with SSRI's, Effexor & Cymbalta as it does with MAOIs. Also, Morphine & Dilaudid are fine to be taken with SSRI's & MAOI's. Demerol was the analgesic most likely to cause serotonin syndrome, but it takes more than one doseage & it is rarely used anymore.
Tyramine induced hypertensive crisis are a source of concern, but an antidote can be carried for this(and for SS). Amphetamines aren't totally contraindicated either, Parnate itself is an amphetamine like chemical & Selegiline which is nearly identical to Parnate does actually metabolize into methamphetamine & amphetamine. The only real problem with MAOIs is cough medicines & decongestants such as pseudoephedrine.
Cheers,
Paul.
poster:Sad Panda
thread:402677
URL: http://www.dr-bob.org/babble/20041012/msgs/402849.html