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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 161 to 185 of 488. Go back in thread:
Posted by jsarirose on July 21, 2002, at 15:07:36
In reply to Re: hypertensive experiences?, posted by cybercafe on July 21, 2002, at 12:55:45
> >hospital care. Each time I used Procardia sublingualy and although can decrease blood pressure - it did nothing to stop the pain (which is like an explosion, gun shot through your head)
>
> ... nifedepine doesn't get rid of the pain?
>
> what can you take to get rid of the pain then? ....
>
> oh and if you have the pain with no rise in blood pressure is it worth taking the nifedepine at all?
>
>
> thanks a lot for the info guys ... i'm going to see my doc tomorrow but i'm still a little confused what to be satisfied withI don't know about nifedepine, but Thorazine seems to help deal with the pain for me. I've taken a pain pill (oxycodone) with and without the Thorazine when I had an attack and the Thorazine definitely helped me feel at least tolerable sooner. It also really wiped me out (but I'd prefer having to sleep for a day or two than deal with the pain a minute longer than necessary). It will also help lower blood pressure if that is part of the problem.
You may want to ask you doctor about that one as well. Especially since it's safe to take whether your blood pressure is elevated or not.
-Jessica
(Pick mine, pick mine! Just kidding')
Posted by Sparkie416 on July 21, 2002, at 16:30:58
In reply to MAOI diet short list, posted by Elizabeth on August 17, 2001, at 13:43:12
> Hi. A couple of people have requested that I repost the dietary restrictions that I followed while taking MAOIs. Please don't take this as gospel; it's what worked for me and it's based on some fairly meticulous library research (I can provide a reading list for anyone who's interested). A lot of the "menus" that get handed out by pharmacies, hostpials, doctors, etc. are not very accurate because they are out of date and place extreme and unnecessary restrictions on what you can eat. This results in a number of problems. Many people are scared off by long, intimidating lists of restrictions. In other cases, a person will discover that s/he can "cheat" on some of the foods (the ones that really shouldn't be on the list) and will therefore take the entire list less seriously. There are some things that you definitely should avoid, but they are relatively few.
>
> So, here it is -- a list of some things that I felt merited avoidance, and others that I felt were safe (and had no problems with, of course):
>
> WINE is fine. Some people may get histamine-related headaches from it and think they are having a hypertensive episode when they are not.
>
> BOTTLED BEERS are usually fine (American and Canadian ones are the best studied).
>
> TAP BEER should be avoided.
>
> Most AGED CHEESES are out. Of note, the mozzarella generally used on most pizzas has been found to be okay. So unless it's some weird exotic pizza with sharp cheeses (feta, cheddar, fontina) it should be okay to eat pizza. (In general, cheeses described as "sharp" are the most dangerous ones.) Ricotta cheese, cottage cheese, cream cheese, and "pasteurized process cheese food" (American cheese -- the cheesiest kind) are okay as well. In regard to the intermediately-aged cheeses, I personally had no problem with jack or brie in moderation. I would be careful if you're going to try this, though, and it's not something I'm willing to say is definitely safe.
>
> OTHER DAIRY PRODUCTS, such as milk, yogurt, and sour cream, are generally safe as long as they are fresh.
>
> SOY FOODS are controversial: one sample of soy sauce was reported to have quite a lot of tyramine in it, but there aren't any documented interactions. My experience has been that a little bit of soy sauce is okay. I would avoid other soy products, such as soy milk and tofu. The Taiwanese dish called "stinky tofu" is probably right out. < g >
>
> Similarly, SAUERKRAUT has been found to contain a large amount of tyramine in some analyses, but there aren't any reactions documented that were associated with sauerkraut.
>
> PROTEIN-CONTAINING FOODS that have passed the expiration date or that may have been stored improperly should be avoided. Fresh milk, meat, etc. are okay. One exception that I make, just because there have been so many problems reported with it, is LIVER; it seems possible that the proteins in liver are especially readily broken down to tyramine (perhaps they include more tyrosine than other proteins do, or perhaps the bacteria that turn tyrosine into tyramine are fond of liver).
>
> Certain AGED MEATS, such as salami, bologna, and some sausages, may be problematic. Err on the side of caution. Some telltale words to look for are "aged," "smoked," "air-dried," and "fermented."
>
> PICKLED HERRING itself isn't a problem, just don't eat the brine (yuck!).
>
> To many people's relief, CHOCOLATE is fine. (If my experience with carb cravings on phenelzine is any indication, it's fine in *huge* amounts!)
>
> Some miscellaneous peculiar foods, such as FAVA BEAN PODS and BANANA PEELS, also cause problems. Shouldn't be a major issue for most people. Watch out for Middle Eastern cuisine, which sometimes contains fava beans. MISO SOUP and other Oriental soup stocks have also been reported to cause problems.
>
> I hope that people find this helpful. As I said, I can provide a list of references if anyone is interested.
>
> -elizabethElizabeth,
Please list the references. I would be interested in reading them
Thanks.
Sparkie
Posted by LLL on July 21, 2002, at 17:37:20
In reply to Re: hypertensive experiences?, posted by cybercafe on July 21, 2002, at 12:55:45
It takes an hour or two or more for the pain to subside. If you're in the ER you're being given I.V. med's at the time.
Posted by LLL on July 21, 2002, at 17:54:54
In reply to Re: MAOI diet short list » Elizabeth, posted by Sparkie416 on July 21, 2002, at 16:30:58
I'm still confused! I don't remember before avoiding frozen dinners (except those in cheese sauces) and now am having to eliminate these because they contain "yeast" or "autolyzed yeast extract". Can someone out there provide documentation confirming that in fact name brand frozen food products containing the above are prohibited?
Also, I went on line to read "The Making of a user Friendly MAOI Diet" in the Journal of Clinical Psychiatry, 1996:57(3):99-104 and there is nothing accessable prior to October of that year. How can I get a copy?
Thanks
Lisa
Posted by jsarirose on July 22, 2002, at 2:52:50
In reply to Re: MAOI diet short list » Elizabeth, posted by Sparkie416 on July 21, 2002, at 16:30:58
To add to the list - remember any pastes are not allowed at all! For example fish paste & anchovy paste. May sound like something you'd never eat, but they actually use some of those pastes in some of the Asian soups. I was sick from some Vietnamese Pho which I found out contains anchovy paste.
Be careful out there,
Jessica
Posted by cybercafe on July 22, 2002, at 2:56:24
In reply to Re: MAOI diet short list, posted by jsarirose on July 22, 2002, at 2:52:50
> To add to the list - remember any pastes are not allowed at all! For example fish paste & anchovy paste. May sound like something you'd never eat, but they actually use some of those pastes in some of the Asian soups. I was sick from some Vietnamese Pho which I found out contains anchovy paste.
really? my mom keeps trying to push the paste on me...
jess you have saved my butt yet again ...
... i am going to have to recommend you charge my health care insurance $500
Posted by jsarirose on July 22, 2002, at 3:02:33
In reply to Re: MAOI diet short list » Sparkie416, posted by LLL on July 21, 2002, at 17:54:54
> I'm still confused! I don't remember before avoiding frozen dinners (except those in cheese sauces) and now am having to eliminate these because they contain "yeast" or "autolyzed yeast extract". Can someone out there provide documentation confirming that in fact name brand frozen food products containing the above are prohibited?
> Also, I went on line to read "The Making of a user Friendly MAOI Diet" in the Journal of Clinical Psychiatry, 1996:57(3):99-104 and there is nothing accessable prior to October of that year. How can I get a copy?
> Thanks
> LisaKeep in mind that any lists written 1994 or earlier are not necessarily accurate. They updated the lists and added many more items. Things they previously thought were verboten are now accepted. They are still not bad guidelines, but it's better to stick with published lists 1996 and later.
Regarding autolyzed yeast and yeast extract, I've seen it listed on many lists. I sometimes question it's inclusion in the zero allowable column however. I've actually eaten some Ramen soup which contains autolyzed yeast with no reaction. I haven't actually tried it since because I'd rather err on the side of caution, but I wonder if a little would really hurt.
Here's one list, but it's published in 1994: http://www.virtualtrial.com/pcvdiet.cfm
This list from Dr. Bob (referenced to McCabe) mentions yeast extracts: http://www.dr-bob.org/tips/maoi.html#avoid
And here's one more: http://leda.lycaeum.org/Documents/MAOIs_--_Monoamine_Oxidase_Inhibitors.13334.shtml
-Jessica
Posted by jsarirose on July 22, 2002, at 3:03:54
In reply to Re: MAOI diet short list, posted by cybercafe on July 22, 2002, at 2:56:24
> > To add to the list - remember any pastes are not allowed at all! For example fish paste & anchovy paste. May sound like something you'd never eat, but they actually use some of those pastes in some of the Asian soups. I was sick from some Vietnamese Pho which I found out contains anchovy paste.
>
> really? my mom keeps trying to push the paste on me...
>
> jess you have saved my butt yet again ...
>
> ... i am going to have to recommend you charge my health care insurance $500Well, toothpaste is okay! You still have to brush, sorry. ; )
-Jessica
ps - shrimp paste is another
Posted by LLL on July 22, 2002, at 10:02:07
In reply to Re: MAOI diet short list » LLL, posted by jsarirose on July 22, 2002, at 3:02:33
> Jess, as always, thank you for your thorough responses. I still have questions because I clearly recall using the frozen diet dinners "Lean Cuisine" etc., the last time I was on Parnate with no incidents and those dinners as well as the other brand names list yeast extract, yeast, or autolyzed yeast extract. I may call the manufacturer because the amount may be so small that restricting the use would be unnecesary.
Raspberries are listed as both not a problem and as a problem in these lists (I have them all). So it makes me question things like bottled raspberry viniagrette dressing. And - if peanuts in large quantity is prohibited - what about peanut butter?
I've written to 2 pharmacists on line and received a response from one who will try to help me further- he's in the UK. This is what he's told me thus far:
The trouble is that there are two problems:
1. Some people are rapid metabolisers of tyramine and in fact hardly need to have a restricted diet
2. Hard data on the exact tyramine content of foods is lacking, and even
then there are variations between brands, it changes over time and one study
even showed local concentrations in one piece of cheese - one chunk had none, another chunk next to it would blow your head off!
I'll post what I find out.
Lisa
Posted by jsarirose on July 22, 2002, at 10:41:32
In reply to Re: MAOI diet short list, posted by LLL on July 22, 2002, at 10:02:07
Please do post if you get a response.
When I see conflicting reports I always look at the date and go with the later one. Usually, it is an item they thought was not allowed and then they realize it's fine.
I've never heard of raspberries causing any trouble and I've eaten fresh raspberries, frozen raspberries, and raspberry jam. Judging from my reaction to other items I would guess I'm a "rapid metabolizer".
And I believe the same is true with peanuts except in very high quantities. I've successfully eaten more peanut butter & jelly sandwiches than I care to admit (and I use pure ground peanuts and don't put it on sparsely).
Some things, like chocolate, do contain tyramine in studies but in practicality you would have to consume so much it really would be difficult to get a reaction. They still tend to include them on the 'use in small quantities' lists though.
There is a list on the web of actual tyramine content in a variety of foods. Here's one (I've seen others but can't find any good ones right now): http://www.migraene.dk/Engelsk/triggers/Tyraminmigr%C3%A6ne-english.htm
General rule of thumb, I believe, is greater than 6mg/serving is a no no, while less than that is allowable in increasing moderation as it nears 6mg.
Another stat for you: A person (not on MAOI) can safely ingest 100mg of tyramine. As the amount increases their blood pressure will increase. 400-500mg causes hypertension. Taking an MAOI causes a 50-fold effect on tyramine levels, hence 6mg of tyramine = 300mg for a "normal" person.
(Paraphrased from a couple sites, including: http://nepenthes.lycaeum.org/Drugs/Misc/maoidisc.html)-Jessica
Posted by jsarirose on July 22, 2002, at 10:53:52
In reply to Re: MAOI diet short list » LLL, posted by jsarirose on July 22, 2002, at 10:41:32
Found one more tidbit: "Approximately 10 to 25 mg of tyramine is required for a severe reaction compared to 6 to 10 mg for a mild reaction." (Source: http://nepenthes.lycaeum.org/Misc/maoi.foods.html)
Granted, this is an older list, but I would think the above rule of thumb is still accurate.And here's an answer to a question I had a while back but never could get answered. I was wondering if you had several items that were each acceptable in small doses if the total effect could give you a reaction. And, how long does it take to clear your system of tyramine. For example, if I had a bunch of coffee in the morning, could I have a bunch more at night? Anyway: "Tyramine gets digested pretty quickly, and likely clears the gut in 12 hours or so."
(Source: http://www.erowid.org/chemicals/maois/maois_info7.shtml)Okay - think I'm done browsing for now (maybe). : )
-Jessica
Posted by LLL on July 22, 2002, at 11:03:16
In reply to Re: MAOI diet short list, posted by jsarirose on July 22, 2002, at 10:53:52
Thanks again. I think I've already read everything out there and have become addicted to my computer as a result! Do you use peanut butter? What about frozen name brand meals/dinners?
Lisa
Posted by jsarirose on July 22, 2002, at 11:15:36
In reply to Re: MAOI diet short list, posted by LLL on July 22, 2002, at 11:03:16
> Thanks again. I think I've already read everything out there and have become addicted to my computer as a result! Do you use peanut butter? What about frozen name brand meals/dinners?
> LisaYes, peanut butter in cooking and sammiches. I've shied away from frozen dinners that contain autolyzed yeast (which is most anything with a sauce). I'm still not convinced that the amount would be enough to trigger an episode, but I'm pretty gun shy these days. When I first started on Parnate I would chance things more and taste more things. Now, after three episodes, I would rather err on the side of caution. I would just love to find some data on the actual mg of tyramine contained in an average serving of something containing autolyzed yeast though. Any friends that are chemists?
-Jessica
(ps - I've found some of the more expensive organic ones don't contain the yeast)
Posted by LLL on July 22, 2002, at 11:48:53
In reply to Re: MAOI diet short list, posted by jsarirose on July 22, 2002, at 11:15:36
I wrote to "Lean Cuisine" and "Healthy Choice" and am hoping to get something back that will be helpful.
Received word from my general practioner in regard to prescribing an antidote for the Parnate - to quote his nurse "he won't touch it." Don't blame him - it's the psychiatrist's responsiblity! I'm sooooo frustrated!
Posted by jsarirose on July 22, 2002, at 11:55:11
In reply to Re: MAOI diet short list, posted by LLL on July 22, 2002, at 11:48:53
> I wrote to "Lean Cuisine" and "Healthy Choice" and am hoping to get something back that will be helpful.
> Received word from my general practioner in regard to prescribing an antidote for the Parnate - to quote his nurse "he won't touch it." Don't blame him - it's the psychiatrist's responsiblity! I'm sooooo frustrated!That is sooo unbelievable! He'll prescribe the Parnate but not the 'just in case' pill? (Is he the one prescribing the Parnate?) That seems highly irregular and dangerous. If he's so uncomfortable prescribing the emergency pill he shouldn't be prescribing Parnate!
-Jessica
(Please correct me if I'm wrong.)
Posted by LLL on July 22, 2002, at 12:00:07
In reply to Re: MAOI diet short list » LLL, posted by jsarirose on July 22, 2002, at 11:55:11
My Psych. is the one prescribing the Parnate and not the antidote and pushing me off on my G.P. Yep, I agree it's her responsibility! I have no other psych. to turn to right now and am just plain stuck! I asked my G.P. if he'd call her and talk some sense into her and I'm awaiting a reply.
Thanks,
Lisa
so glad to hear peanut butter's OK!!!! :-)
Posted by cybercafe on July 22, 2002, at 13:29:19
In reply to Re: MAOI diet short list, posted by jsarirose on July 22, 2002, at 10:53:52
>acceptable in small doses if the total effect could give you a reaction. And, how long does it take to clear your system of tyramine. For example, if I had a bunch of coffee in the morning, could I have a bunch more at night? Anyway: "Tyramine gets digested pretty quickly, and likely clears the gut in 12 hours or so."
i'm sure it must depend on how much there is to begin with...
.... if say 50% is metabolized after 30 min, you could probably get away with .... one half the max tyramine content every half hour.... or... 31% every fifteen minutes...
the half life of tyramine in a beverage must be much less than that in a solid since it can make it's way down the alimentary canal much more easily, and has a greater surface area and is more more easy to break down (being liquid) etc etc etc
Posted by Bobbiedobbs on July 23, 2002, at 23:01:32
In reply to Re: MAOI diet short list, posted by jsarirose on July 22, 2002, at 2:52:50
Re one poster's question about soy products, I spoke today with GlaxoSmithKline's expert (via a customer service rep) who said soy protein and soy flour are safe to eat to the extent that they are not "aged or fermented in any way." As to whether they are or not, they said I'd have to contact the soy products manufacturers. That leaves open the question. I suggested that the drug maker update their food list to reflect soy-based products. They (apparently) don't intend to, as there are too few people taking this product to justify the effort. I agree with Jessica's earlier post regarding soy and soy flour, Marsala wine in cooking and chicken broth made without yeast (all safe). But that's just my opinion.
The list published by Strong Memorial Hospital Pharmacists in 1998, which appeared on the Univ. of Rochester web site, said to "avoid" "soy sauce and other soybean condiments" but that "soy milk" was specifically "allowed." It also said that no more than 4 ounces of wine per day was OK. Another site says you can consume a "moderate" (defined as 1/4 to 1/2 cup total per day) of the TOTAL of a wide array of items, including, among others: buillon, commercial breads without or low in yeast, MSG, and terriyaki sauce (which it specifically limits to 2-4 tbsp a day).
One poster requested the address to get a copy of the University of Toronto study - which I believe is the most definitive to date on MAOs. I don't know if this is still a good address, but in 1996, I wrote to Kenneth I. Shulman MD, Dpt. of Psychiatry, Sunnybrook Health Science Center, 2075 Bayview Ave, Toronto, Ontario, Canada M4N 3M5 and received a detailed response to my questions. The phone (again back in 96) was 416-480-4079. The name of the study is, "The Making of a User Friendly MAOI Diet," by David Gardner, Kenneth Shulman, Scott Walker and Sandra Tailor. Reprint requests to: Kenneth Shulman, M>D. S.M. F.R.C.P. (C), Dept. of Psychiatry, and the rest as above. This diet says that MSG, soy milk and yeast extracts except Marmite are fine but to avoid soy sauce and soy condiments. It goes into enormous detail. They studied )a) how much tyramine was actually in a variety of food products and (b) whether there has actually been any documented instances of reactions to any of the no-nos. Conclusion: ""Many MAO diets are excessively restrictive and without solid science." For those who drink or want to drink beer and alcohol, there's a second study that lists the amount of tyramine in hundreds of beers. It is called, "Hypertensive Episode Associated with Phenelzine and Tap Beer...". available at the same address from Sandra Tailor. Everything was fine except a bottle of Kronenbourg on tap (horror show) and tap versions of Upper Canada Lager and Rotterdam Lager. None of the bottled or canned beers presented any problem. The conclusion was that it is not the alcohol, but the process in which certain tap is made - a secondary fermentation process which apparently allows bacterial growth and tyramine production. This process does not occur in the popular, bottled beers.
Sunnybrook Health Science Center's MAOI Diet, which I generally follow, says to avoid all cheese except fresh cottage cheese, cream, ricotta, processed cheese slices, and allows no more than 2 domestic bottled or canned beers (including nonalcoholic) or 4 fluid ounces glasses of red or white wine per day.
Phil
Posted by Bobbiedobbs on July 23, 2002, at 23:21:15
In reply to Re: MAOI diet short list, posted by Bobbiedobbs on July 23, 2002, at 23:01:32
Can't resist one more stab at the TV dinner issue (I believe they are now referred to as "frozen dinners."). I did a more careful estimate and figure I have consumed approximately 4,000 frozen dinners, the great majority of them which listed autolyzed yeast, etc., among their ingredients, without THE SLIGHTEST reaction. This on up to 60 mg. of Nardil and 50 mg. of Parnate. Not to be glib, but I'd worry more about the chemical soup in the frozen dinners generally.The frozen dinners help me with portion control, plus they are better than anything I could cook without alot of effort - particularly most of the Lean Cuisine products.
Posted by jsarirose on July 23, 2002, at 23:22:21
In reply to Re: MAOI diet short list, posted by Bobbiedobbs on July 23, 2002, at 23:01:32
It also said that no more than 4 ounces of wine per day was OK. Another site says you can consume a "moderate" (defined as 1/4 to 1/2 cup total per day)
> Sunnybrook Health Science Center's MAOI Diet, which I generally follow, says to avoid all cheese except fresh cottage cheese, cream, ricotta, processed cheese slices, and allows no more than 2 domestic bottled or canned beers (including nonalcoholic) or 4 fluid ounces glasses of red or white wine per day.
> PhilWith cheeses, don't take the lists provided as total - basically fresh cheeses (what they list) are fine, including mozzarella! If you're craving a cheese that melts, like I was, mozzarella is your friend! Plus, they seem to come out with new cheeses all time. I always find out if it's a "fresh" vs. aged cheese and go for it if I'm positive it's fresh. (Usually the white creamy cheeses.)
RE: soy sauce, I've seen numerous sites that say it's okay in limited amounts, no more than a tbsp. Since I've been fine on that, I see no reason to exclude it from my diet. (Personal choice.)
RE: alcohol. I have also ready varying amounts for red and white wines, and beer some more generous than others. I, personally, have interpreted this to be 'in moderation'. I have had as much as three glasses of red wine & champagne in an evening with no averse effects. I've also had three or so beers and been just fine.
The issue with beer, is as Bobbie said - the danger lies in possible moldy or unclean processes. That's why tap beer & homemade beer are no's, and some of the smaller microbrews are questionable and therefore taboo (in my mind). I also extrapolated this to mean the homemade wine my friend gave me should be totally off limits. (Didn't want to chance it.)
I've had all types of hard liquors, in moderation, with no adverse effects as well.
Please note: these are MY opinions and MY experiences, your mileage may vary.
-Jessica
Posted by jsarirose on July 23, 2002, at 23:26:06
In reply to Re: MAOI diet short list » Bobbiedobbs, posted by jsarirose on July 23, 2002, at 23:22:21
I have a new question that I haven't been able to get answered:
I've had numerous (legal) fresh mushrooms, many types of wild, with no ill effect. And I wouldn't expect any.
I'm wondering about dried mushrooms, for instance, shitakes often come dried. I don't think they are technically aged so they should be okay, but sometimes they look like they've been around a while. Any idea if they're okay? Any guesses on whether you think they would be okay?
-Jessica
Posted by LLL on July 24, 2002, at 8:47:26
In reply to Re: MAOI diet short list » Bobbiedobbs, posted by jsarirose on July 23, 2002, at 23:22:21
My heartfelt thanks to you both for these 3 posts.
Lisa
Posted by LLL on July 24, 2002, at 9:28:58
In reply to Re: MAOI diet short list » Bobbiedobbs, posted by jsarirose on July 23, 2002, at 23:22:21
Somehow my prior thread got mixed up with someone commenting on mood disorders. Want to thank you both, Jess and Phil, for being so very helpful and patient. As my anxiety subsides y'all will here from me less. Promise!
Lisa
Posted by jsarirose on July 24, 2002, at 14:03:55
In reply to Re: MAOI diet short list » Bobbiedobbs, posted by LLL on July 24, 2002, at 8:47:26
> My heartfelt thanks to you both for these 3 posts.
> LisaAbsolutely no problem! That's what these lists are for - sharing information. And I know from my own struggles with trying to get a grasp of the intricacies of the "diet" that it takes a while to really understand it. Soon you'll be able to make your own educated decision on many items.
Of course, we all need to post questions from time to time - hence my question about dried mushrooms.
Take care,
Jessica
Posted by cybercafe on July 24, 2002, at 16:26:22
In reply to Re: MAOI diet short list, posted by Bobbiedobbs on July 23, 2002, at 23:01:32
Hey thanks a lot Philthey are quite good there -- not only do they answer their phone lines, but apparently i can go down there and pick up a copy for free...
i'm just wondering though.. does it list the tyramine content of different brands of soy sauce ?
btw - yes it's still the correct phone no for Dr. Shulman's secretary
hmmm... actually the 1999 report seems interesting too:
Refining the MAOI Diet: Tyramine Content of Pizzas and Soy Products
Kenneth I. Shulman, M.D., S.M., F.R.C.P.(C)., and Scott E. Walker, M.Sc.Pharm.(J Clin Psychiatry 1999;60:191Ð193)
--------------------------------------------------------------------------------Received March 22, 1998; accepted June 30, 1998. From the Departments of Psychiatry (Dr. Shulman) and Pharmacy (Mr. Walker), University of Toronto, Sunnybrook Health Science Centre, Toronto, Ontario, Canada.
Reprint requests to: Kenneth I. Shulman, M.D., Department of Psychiatry, Sunnybrook Health Science Centre, 2075 Bayview Ave., Toronto, Ontario, M4N 3M5, Canada.
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