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Re: i have a MAOi prescription - parnate ?? Radish

Posted by Couleuvre on July 3, 2019, at 6:52:19

In reply to Re: i have a MAOi prescription - parnate ??, posted by Radish on July 1, 2019, at 8:09:29

> Yeah maybe my pdoc assumes I care about weight gain (Im a woman), even though I could tolerate it given a drug *actually* works.

I felt that way when I tried Nardil too, but the weight gain got really bad. While a little bit of weight gain isn't a big deal if you're not already overweight, it can become a serious health problem, especially if your lifestyle isn't very active generally. It's far from being a merely cosmetic thing.

> But he didnt say anything about anything. He says very little in general.

A lot of doctors are like this, for various reasons. Sometimes I get the sense that they're just quiet types, maybe even kind of shy, but others seem to assume that patients wouldn't understand anything they said anyway, which I find exceedingly annoying. Whatever the reason, you need to ask them questions in order to get them to be more clear about things (and if the "medical arrogance" thing is the cause, you need to make it clear that you're not content simply to follow orders and that you're not an idiot, that they should be able to give reasons for anything they want you to do).

> He is very hard for someone with social phobia to talk to, otherwise Id ask him questions, but my mind goes purely blank.

I think I understand what you're talking about. I had really bad performance anxiety when I was a kid, esp. in secondary school. While I was okay in casual social situations, speaking in front of an "audience" or the like (e.g. talking to an adult who I didn't know well) was really hard. One time I had to give a book report and I just froze up and couldn't think of anything I had meant to say!

Something that I found helpful was bringing notes, like a list of questions I wanted to ask or points I wanted to make. My English teacher was very cool about it I think she may have known someone, maybe even a close family member, who had social anxiety and she let me try again with notes: it went a lot better. Similarly, I tried joining the speech & debate team in hope that it would help me learn to speak in front of audiences. First I tried the S&D event that doesn't require much preparation and that was just standard for people to try fist, extemporaneous speaking ("extemp"). The way it worked was that you'd pick a topic out of a box and have 30 minutes to prepare what you wanted to say on the topic, then you would speak for 5 minutes or something like that, as would your opponent. I thought the topics were pretty simple and straightforward, but when it came to actually speaking in front of the judge and opponent, I was awful! I also tried original oratory (giving a speech that you had written, because I liked to write
I switched to Lincoln/Douglas debate, where you could have notes. There was a single topic which changed only something like once a month or something like that, much more complex than the extemp topics, and you had to prepare to argue both "affirmative" and "negative" on the issue. The main thing for me, though, was that you were allowed (indeed, supposed) to have notes. That made all the difference: I had finally found an event that worked for me.

Bringing along notes is something that a lot of people do when going to the doctor, so you don't need to worry that it will seem weird or anything. A list of questions you want to ask, issues you want to bring up, even some scripted bits, like how you're going bring things up, etc.

> Im just thankful he is willing to try MAOIs because I know many doctors have a blanket no-MAOI policy. Im glad its working fairly well for you (alongside other things) and I hope it works for me too.

It's sure true that a lot of doctors still have this exaggerated phobia of MAOIs because of the possibilities of hypertensive crisis and serotonin syndrome. If it helps, the food interactions have been greatly exaggerated, and are often based not on randomised controlled trials but on a single case report. That doesn't mean you can just neglect all of them -- there are some real problem foods, but the list is not nearly as long as many doctors will still claim. I have a book (which I can't find right now because my room's a dump) called _Clinical Advances in MAOI Therapies_. It's not up-to-date (it was published in '97, and as far as I know there isn't a new edition), but it's still relevant, debunking a lot of the food-interaction assumptions that have been accepted for decades without question, that a lot of doctors still accept. I think (based on personal experience) that drug interactions are much more serious.

I hope it does the trick for you. If it helps, my problems have been exceptionally intransigent: I'm hoping you won't have as hard a time finding something that does the trick for you. Also, depression is my main issue, not anxiety.

Cognitive approaches (based on stuff I had read about cognitive-behavioural therapy for social anxiety, so pretty much the same stuff a cognitive therapist would want you to do) helped me deal with the worst of the performance anxiety so that by the time I graduated from high school it was a lot less of a problem. When I tried MAOIs, while I was at university, I found that they did away with the remaining anxiety entirely, and that Parnate worked just as well as Nardil without the weight gain.

I had one other really serious side effect from Nardil, although it's not a common one like weight gain is: hypomania. Because I'm not bipolar, I didn't recognise what was happening, even though I knew what hypomania is. I think my doctors probably didn't recognise it since it was mixed with the partially-treated depression, so it didn't look like what they thought of as hypomania, plus I didn't have a history of bipolar-type symptoms so they wouldn't have expected it. I think they tended to interpret it as anxiety, atypical depression (even though that's another thing that was really inconsistent with my history), etc. At the time, the only kind of mixed state described in DSM (I think it was IV or IV-R) was mania and depression, and I had never heard or read anything about the concept of mixed hypomania/depression. Although antidepressant-triggered mania and hypomania wasn't unknown, I think it was expected that there would be some hint, like a personal or family history of bipolar d/o, mood swings, sub-threshold hypomanic symptoms, etc., and that it would manifest as straightforward hypomania or mania. I was still depressed, but I kept doing stupid, impulsive things (mainly involving overspending) and not recognising that it was a pattern or associating it with the Nardil; there was probably some wishful thinking involved here, because it was the first thing that had worked for me even partially, so I was afraid to have to stop taking it. I only came to this conclusion some years later, in a different city, when telling my psychiatrist there about it. He got really interested in my family history after that, but the only thing he thought might have been a clue was my maternal uncle's alcohol addiction (no addiction in any of his children, either of his parents [my grandparents], his sister [my mother], ...)

> Just to speculate more...Ive read that parnate is not fully irreversible like Nardil, so maybe its somewhat safer. Maybe hes concluded my issue is not serotonin based given my non-response to multiple SSRIs, and Nardil has a greater effect on serotonin.

My experience in general is that at antidepressant doses, both are irreversible MAOIs. RIMAs like moclobemide, while effective, don't seem to be especially helpful for people like us who've tried all the standard treatments.

It's important to [umm, can't think of a word for this, but it's like tapering, only upward instead of down] gradually so that you catch any side effects when they're still modest (plus higher doses probably have a higher risk of triggering mania/hypomania). I'd start with 10mg, then increase by 10mg each week until you reach 30mg, the usually accepted minimum effective dose. continue increasing slowly (10-20 mg every week or 2) until you either reach a dose that is effective or experience intolerable side effects. During this period you and your doctor both need to be on the watch for adverse reactions. (The dose range can be quite large: some people only need 30mg; I take 80 with hardly any side fx.)

Parnate could be considered an amphetamine analog (luckily, the FDA doesn't seem to have noticed this): the trans- isomer of a substituted amphetamine: the cyclopropyl ring is built from the ethyl and methyl groups on amphetamine's side chan. Some people find it a little activating, and there's the potential for cardiovascular side fx, like increases in BP, heart rate, etc. (My pulse has been somewhat higher since I've been on it, but my BP is on the low side, and my doc says it's not dangerous.) This is something to keep an eye on.

Anyway...good luck & best wishes!

-Couleuvre


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