Posted by ed_uk on April 9, 2006, at 19:05:28
In reply to MAOIs and feeling drugged, posted by Caedmon on April 9, 2006, at 16:24:50
Dear C,
The following is not an attack on you :) It's an attack on the dreadful article!!!
http://www.webmd.com/content/Article/87/99355.htm?pagenumber=1
I just read the link. It's awful. VERY predictable. Just the sort of thing you read about MAOIs all the time, invariably written by people who don't know anything about them.
>But for a chocoholic, the dietary restrictions were torture
Many people find that they don't need to avoid chocolate, particulaly American chocolate. The MAOI diet is usually overexaggerated.
>Excess tyramine can cause a sudden, sometimes fatal increase in blood pressure so severe that it can burst blood vessels in the brain.
In patients who suffer a hypertensive crisis, fatalities are very few and far between.
>Because no one knew about the tyramine connection, a wave of deaths from brain hemorrhages swept the country.
A wave? An exaggeration perhaps?
>60 mg/day
60mg is NOT the maximum dose of phenelzine. Another sign that this was written by someone who doesn't know what they're talking about.
>"I call it the 'St. Jude' drug," says psychiatrist Andy Myerson. "It's the drug I use when nothing else works and someone is willing to give up anything in the hope that something will help their depression."
Sounds like the sort of pdoc who starts a severely depressed patient on an SSRI after they've previously tried every single SSRI, at every possible dose, in every possible combination without a hint of relief. Give up anything? Like cheese? How awful! The hope that something might help? Well yes, an MAOI antidepressant IS likely to help.
>They (MAOIs) are especially good if you seem mildly depressed, if you become depressed more gradually, or if your primary complaints are boredom.......
Mildly depressed? Bored? Who wrote this?
>One of the big problems with MAO inhibitors is that they may make you feel drugged and sluggish. "I didn't respond to tricyclics at all five years ago," says Karen, a New Jersey graduate student who has been chronically depressed most of her life. "When I was switched to an MAOI, I responded very well. But I couldn't take the diet. After I finally went off the drug, my friends told me I was always in a daze while I was taking MAOIs, but I wasn't aware of that at the time. I was switched to Prozac four years ago, and I've been taking that ever since." Patients often look dazed or even robotic, much the way Karen had appeared to her friends.
Sounds like an advert for Prozac to me. Dazed and robotic? Has the author ever prescribed an MAOI? Severely depressed patients may well appear dazed. So lets blame the MAOI. After all, docs seem to blame them for everything else. Funny how, when I was dazed on Paxil, no one considered that it might be due to the Paxil. This sort of 'case report' really is remarkably nauseating in a world where we're constantly surrounded by the glowing faces advertising the latest psych meds on television.
>"A lot of patients are resentful about the diet they have to follow," explains Dr. Myerson. "They tend to blame the doctor when they can't eat their favorite foods, and many people simply won't follow the diet." Other mental health experts point out that MAO inhibitors often interfere with the relationship between doctor and patient, because people feel so resentful about their side effects and diet that they don't want to talk to their doctor during therapy.
OK, now this really is the dumbest thing I ever read. Who are these 'mental health experts'? Are they currently writing on WebMD warning that psychiatry's latest wonder drugs may interfere with doctor-patient relationships when patients loose their libido to such an extent that their marriage disintegrates. I have noticed many times that patients who suffer side effects on MAOIs are actually less resentful than patients who suffer side effects on newer meds. It would appear that patients on MAOIs are the only people who are being properly warned that side effects may occur. A doctor's dismissal of a patients side effects (or withdrawal symptoms) is what leads to people being resentful.
>Their relatively risky profile makes them a poor choice for potentially suicidal patients who might intentionally take an overdose.
Oh, a bit like Effexor then? - which can cause serious cardiac arrhythmias, convulsions and serotonin syndrome in overdose.
>At very low doses, the MAOIs can have toxic effects on the heart, unlike Prozac, which is not considered toxic even at very high doses.
Back to the Prozac ad again. I have never heard of MAOIs being cardiotoxic. Reference please?
>Studies have shown that MAOIs are not associated at all with suicide in nonsuicidal patients, as opposed to most other antidepressants. In a 1991 Harvard University study of 1,017 depressed people, 63 nonsuicidal patients took an MAOI and none became suicidal.
:)
>"I've seen a few miracle cures with these drugs," one psychiatrist noted. "And they're particularly good if people suffer from panic attacks in addition to depression."
Perhaps he'd see a few more if he prescribed them more often!
>Furthermore, if you have hypertension or heart problems, the MAOIs might be for you because at therapeutic doses, they can lower blood pressure. In contrast to the tricyclic antidepressants, MAO inhibitors have little negative effect on heart rate.
Nardil tends to lower heart rate slightly. TCAs tend to increase heart rate.
>Tolerance
Some people develop a tolerance to MAO inhibitors. This could mean that the drug will work for you at first, but you could suddenly become depressed again in the middle of treatment.Errrrr excuse me, why don't other classes of ADs have a tolerance warning? Many people find that other ADs 'poop out'.
>They are very good at treating eating disorders—but the weight gain they often cause can be counterproductive. Prozac, on the other hand, is just as effective as an eating-disorder treatment, without the unwanted side effects. In one recent study of 400 women, Prozac cut down on eating binges in 63 percent of the responders and vomiting in up to 57 percent.
Back to Prozac.....
>For social phobics, for whom the idea of a social occasion can produce a range of negative emotions and symptoms, MAOIs (especially Nardil) can be very helpful. In fact, studies suggest that about 70 percent of people who are social phobics respond to MAOIs. Recent research has suggested that PROZAC may also be effective for this problem.
Anyone noticing a pattern here?
Regards
Ed
poster:ed_uk
thread:631034
URL: http://www.dr-bob.org/babble/20060408/msgs/631100.html