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Re: Went to pdoc today ... what do you think?

Posted by yxibow on May 4, 2006, at 20:28:45

In reply to Re: Went to pdoc today ... what do you think? » yxibow, posted by ed_uk on May 4, 2006, at 14:45:25

> >And deadly, potentially.
>
> Yes, but death is extremely unlikely. An MAOI-induced hypertensive crisis can be treatment relatively easily. A lot more people will have died of heart attacks, strokes etc following the use of atypical APs such as Zyprexa.

And death with ECT is also extremely likely when done at proper research institutions who have been practicing it for years. And as far as Zyprexa -- the lipid profile issues can be detected at your doctors office a lot quicker than would cause deadly heart and brain issues with simple tests, as opposed to something that requires the golden hour to the hospital if you're about to have a heart attack from an MAOI.

> >It's not just MAOIs that contraindicate OTC medications - warfarin, and other drugs too
>
> I'm not quite sure what you're saying here. MAOIs do not interact with warfarin.

No, I was implying that other drugs besides MAOIs are also a problem with OTC medication. It was just a side tangent.

> >Yes, there is a chance of short term memory loss
>
> There is a chance of long term memory loss, as many patients who've had ECT will tell you.

Again -- that comes back to the argument of what is better, severe depression, or the chance, whatever it is, of cognition issues. It may be worse with ECT, but you're still balancing risky things with MAOIs.

> >risks of general anaesthesia
>
> Modern anesthesia is very safe. The anesthesia used for ECT is brief, and relatively 'light'. The main risks come from having an electric shock to the head.

It is -- about 1 in 10000 die, usually from improper monitoring, idiopathic reactions, or lack of monitoring medications that may interfere.

> >Sure, if your life depended on what is essentially adult supervision and your doctor was sure you were going to jump out of the window, you couldn't exist in life otherwise, then an MAOI is awfully appropriate. But the casual use of them I think is personally dangerous.
>
> At what point did I suggest that MAOIs should be used casually? In order to take an MAOI safely, the patient requires knowledge, not 'adult supervision'.

I was being a bit overboard, and didnt mean it pejoratively. Serious knowledge though.

If a patient was about to 'jump out of the window', admission to hospital would probably be appropriate.

...where an MAOI might be administered in a safe environment.

MAOIs are particularly suitable for severe atypical depression and/or social phobia. You do not need to be suicidal to take an MAOI.

No... but that's one criteria. Exhaustion of other less dangerous choices are others.

Its really tomato, tomahto, because I just can't see the idea of a medication that you have to carry along the equivalent of an anti-hypertensive, a nitroglycerin like tablet necklace to stop a crisis that could kill you in rush hour traffic. Alot who have had their lives changed around will disagree, and that's fine. Its just not my choice and I dont think it should be any doctor-patient relationship's first choice either.

 

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