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Re: First post/ which a.d ? Robert35

Posted by SLS on February 11, 2006, at 9:46:54

In reply to First post/ which a.d ?, posted by Robert35 on February 11, 2006, at 7:56:52


I think the most obvious alternative to what you have already tried is an MAOI. The two drugs that are most often chosen in the US are Parnate and Nardil. Both are known as being irreversible because once they disable the MAO enzyme, a new one must be synthesized to replace it. It will never function again once Parnate or Nardil adhere to it and disable it. One must adhere to a special diet that avoids a protein substance known as tyramine, the ingestion of which can produce a hypertensive crisis. Tyramine is often found in protein foods that are aged or smoked.

If you are uneasy trying one of these irreversible drugs, you could do a quick trial of moclobemide at 600-900mg per day. It is an MAOI, but is reversible and has a short half-life. One can safely ingest up to 50mg of tyramine in a given meal. If you respond to this drug at all - even if only for a week - you can then justify going for the irreversible MAOIs like Parnate and Nardil. I am not a big fan of moclobemide. It does not have a success rate equal to a drug like Prozac, but many people do profit from it. Nevertheless, the drug is attractive because it acts quickly - usually within the first week - and produces few side effects. It is usually devoid sexual side effects.

Since pain is a consideration, you could try either venlafaxine or duloxetine. You might glean both an antidepressant effect and some degree of an antinociceptive (analgesic) effect. Both drugs have a higher success rate than Prozac. This is because they inhibit the reuptake of both serotonin and norepinephrine. This is a property they have in common with clomipramine.

- Scott




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