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Re: Husbands Suggestion of Nardil for me

Posted by undopaminergic on April 18, 2008, at 21:57:18

In reply to Husbands Suggestion of Nardil for me » Phillipa » Racer, posted by SLS on April 18, 2008, at 6:00:43

> Hi Racer.
>
> IMHO, Nardil is the second most efficacious drug on the planet. Clorgyline is the first. Both of these drugs are potent inhibitors of MAO-A.
>

I read an article today concluding that trimipramine wss more effective than MAOIs (phenelzine and isocarboxazid) in most cases. As is well known, of course, in certain subgroups TCAs are ineffective while MAOIs work great.

Targeting MAO-A makes sense if you're more interested in boosting serotonin and noradrenaline. For extracellular dopamine, it is more logical to target MAO-B (and COMT, in theory), with MAO-A as a secondary target. Inhibition of intracellular MAO-A (*) is associated with downregulation of tyrosine hydroxylase activity, which to a considerable extent defeats the effects of MAO inhibition. (* there is very little intracellular MAO-B.)

>
> I find the MAOIs to be generally tolerable. ... I am surprised that these drugs should be regarded as poorly tolerated.
>

There is much mythology surrounding MAOIs, and unfounded beliefs that are constantly repeated without questioning. That said, however, phenelzine in particular seems to be quite a challenge to tolerate for many people. Even if most of the side effects eventually subside, which isn't guaranteed, the initial phase must be endured before significant antidepressant efficacy to develops. This makes Nardil one of the lasts resorts. Personally, I'm not even ready to resort to tranylcypromine (or high-dose selegiline/rasagiline) yet.

>
> As far as Jan is concerned, I am frustrated and angry. I am aware of her treatment history, and things that are "first-line" drugs have already been tried. I agree with her that it would be beneficial to attack the endocrine system at this point. However, for recalcitrant anxiety, Nardil is a great drug. Marplan would be another consideration in place of Nardil, as it is more tolerable and easier on the liver.
>

I just found this, which may be of particular interest in the case of Phillipa:
http://www.ithyroid.com/mao_and_tsh.htm

Anyway, I agree that the hydrazine MAOIs (phenelzine, isocarboxazid) probably would be the most suitable MAOIs for Phillipa due to their GABAergic (and hence anxiolytic) properties, which are not shared by other MAOIs (tranylcypromine, selegiline, etc.).

I didn't know Marplan was easier on the liver; I thought it was the other way around, as the prescribing info (PI) for it expresses some concern about hepatoxicity. Similar prominence is not give to these concerns in the case of Nardil. If I'm not mistaken, hepatoxicity was the primary reason for the discontinuation of iproniazid, the original MAOI.


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