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Re: My pdoc: 'After Nardil, that's it with meds. ECT'

Posted by blueboy on August 20, 2007, at 16:31:23

In reply to My pdoc: 'After Nardil, that's it with meds. ECT', posted by Girlnterrupted78 on August 20, 2007, at 6:40:02

> (2) Second: It turns out that my Nardil induced rash "is NOT caused by Nardil either." "You've been on Nardil for several weeks. It makes NO sense that NOW you get a rash. Nope, it's not Nardil."

Well, welcome to the irrational world of "MD gods". Boy is it irritating.

The guy just does not have experience with MAOI's. Lacking experience, he just assumes that whatever is in his brain is correct. A very common or even universal human mistake, btw. The best thing medical schools could do is to require a one-hour semester course in decision-making and human heuristics (a fancy word for "how people come to use rules of thumb, how people distort information based on preconceptions, and how well they make decisions based on incomplete information").

He does not realize that MAOI side effects can appear, disappear, and reappear with no apparent rhyme or reason.

> (3) Third: "Parnate is not a choice for you if Nardil fails. It's just another MAOI. They work the same way. If Nardil doesn't work for you, Parnate won't work either."

Inexperience.

> (4) Fourth: "After Nardil, there's nothing else besides ECT, and you know we don't do that at this clinic."

There's lots of other stuff. At my last visit with my pdoc, he suggested Ensam, lithium, ECT, and even thyroid-hormone therapy as things to consider if I didn't want to go back on Nardil.

There are a number of MAOI-A and MAOI-B products, as well as non-reversible general MAOI's. Ensam, which is a current pdoc fad, is new and very expensive, but the underlying drug, selegiline, is generic and at lower dosages is specific to MAO-B. (Ensam is different because it delivers the drug by patch.)

> So what exactly is the deal with this pdoc?

He's too lazy, scared, pompous, or ignorant to learn some new stuff and/or experiment with drugs he hasn't prescribed before.

>Isn't there other choices besides Nardil?

Yes, but less than 1,000.

>Isn't Parnate completely different from Nardil?

No, it's fairly similar. He at least has a point here. If the problem is that Nardil isn't working, he might be justified in saying Parnate isn't worth trying. If Nardil is working but the side effects are intolerable, then no, he's just being a jerk.

>Aren't blackouts a normal side effect of Nardil?

I have never heard this before. I just checked a number of online articles and blackouts are not mentioned as even a rare side-effect in any of them. I'm not saying that they are NOT a side-effect -- this is a powerful and rather weird and poorly understood drug -- but to answer the question you asked, AFAIK the answer is "no, blackouts are not a normal side effect of Nardil".

>Isn't the rash RELATED to Nardil, if it appears 20 minutes after EACH dose of Nardil?

My personal guess is yes. However, I would also say that if the rash appears 20 minutes after you take it, you might want to consider stopping it, as this sounds something like an allergic reaction that could become severe. It would worry me a lot.

> I don't know what to do or what to say anymore. If Nardil fails, I will be left without treatment. This is the best and cheapest and closest clinic I've found so far, and this pdoc, although obstinate, is the only one that agreed to prescribe MAOIs in the last 4 years of searching, so I fear that if I switch, I will be even more limited in my med choices.
>


> I don't think I want to do ECT, does it even work for atypical (treatment-resistant) depression + social anxiety?
>
> Any comments appreciated.

Well, if cost is a major factor, ECT is out anyway. It's way expensive because it has to be done under general anesthesia. Figure $3000-$6000 for one course, and any improvement is temporary.

Can you save up your money and make an appointment/take a trip every two months to a great clinic? Or just go once, even if you have to ride a bus all night?

I'll tell you what else helps pdoc's a LOT, and that is to keep a written diary of the drugs you take, some sort of objective test of your mood (I use a 1-10 scale based on objective things, like I get a "4" if I take a shower.) If you can get a spreadsheet program to keep it on, that's even better.


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