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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by Ted Abel on October 19, 2002, at 13:17:12
I have been on Nardil for a mumber of years now. Its benefit is starting to diminish. I want to augment it. I have already tried lithium and pindolol, with no positive results.
What else might work? Can tyrosine or d-phenyline be added safely?
Posted by metiron on October 19, 2002, at 14:40:23
In reply to maoi augmentation, posted by Ted Abel on October 19, 2002, at 13:17:12
I've recently had to switch from zoloft to effexor after eight years, but on both I still had/have hypersomnia symptoms, so my doctor tried me on provigil,but I got severe headache. So I switched to adderal. Then I did some research on adderal and found out it is an amphetemine. Scary!! I read some of the links here where people reported that they got hypersomnia from effexor, so, I'm concerned that I'm having to take more adderall (scary amphetimine) just to make up for side effects of effexor. And obviously just concerned about taking adderall. I also heard that maoi's are good for atypical depression and wonder if that might be more up my alley. Anyone have any comments or experiences with this?
Posted by jsarirose on October 21, 2002, at 1:37:50
In reply to maoi augmentation, posted by Ted Abel on October 19, 2002, at 13:17:12
> I have been on Nardil for a mumber of years now. Its benefit is starting to diminish. I want to augment it. I have already tried lithium and pindolol, with no positive results.
> What else might work? Can tyrosine or d-phenyline be added safely?I take Parnate, I'm not sure if the augmentation for Nardil follows the same path. I know Lithium is the most common one to try. I've also tried a couple antipsychotics like Risperdal and Zyprexa (couldn't handle either, they totally knocked me out). I am know taking Lamictal with Parnate and it seems to working okay so far. I'm still ramping up so I can't comment completely, but you may want to ask your doctor about it.
-Jessica
Posted by SLS on October 22, 2002, at 7:12:30
In reply to Re: maoi augmentation » Ted Abel, posted by jsarirose on October 21, 2002, at 1:37:50
Hi.
> > I have been on Nardil for a mumber of years now. Its benefit is starting to diminish. I want to augment it. I have already tried lithium and pindolol, with no positive results.
> > What else might work? Can tyrosine or d-phenyline be added safely?Generally, but not always.
> I take Parnate, I'm not sure if the augmentation for Nardil follows the same path.
Generally, I think this is true, but with a few exceptions. I think Parnate is less likely to produce significant drug-drug interactions than is Nardil. One strategy that is often overlooked is to try using very high dosages of Parnate. Many people, myself included, have gone up to 120mg and occasionally higher. I am familiar with at least one case in which the patient did not respond until he raised the dosage to 300mg.
Combining a MAOI with a tricyclic can be very effective. One of the tricyclics, desipramine (Norpramin), is safe to add to either Nardil or Parnate. In addition, I have found that for Parnate only, imipramine (Tofranil) and nortriptyline (Pamelor) are also safe. However, Nardil and Parnate are very different drugs, despite their both inhibiting the MAO enzyme (monoamine oxidase).
Recently, when I tried adding either nortriptyline or imipramine, I developed Serotonin Syndrome, a potentially serious reaction that can occur when two very serotonergic drugs are combined. Both of these tricyclics do inhibit the reuptake of serotonin (5-HT); imipramine more potently than nortriptyline. However, desipramine affects only norepinephrine (NE).
It is my guess that Nardil affects serotonin substantially more than does Parnate. This might be why Nardil is so effective for a wider range of psychiatric conditions (social anxiety, atypical depression, OCD). This would be consistent with my disparate experiences when adding serotonergic tricyclics to Nardil versus Parnate.
A stimulant such as amphetamines (Dexedrine) and (Adderall), methylphenidate (Ritalin) can also be combined with both MAOIs, and even with MAOI - tricyclic combination described above.
Other "mood-stabilizers) such as Lamictal and Neurontin are often good to try.
Sorry. Too long.
- Scott
Posted by jsarirose on October 22, 2002, at 19:07:31
In reply to Re: maoi augmentation » jsarirose, posted by SLS on October 22, 2002, at 7:12:30
> One strategy that is often overlooked is to try using very high dosages of Parnate. Many people, myself included, have gone up to 120mg and occasionally higher. I am familiar with at least one case in which the patient did not respond until he raised the dosage to 300mg.
>I agree. From what I've researched, you can continue to benefit from Parnate up to doses of 130mg. After that, while people have gone much higher, they don't believe there is any additional benefit. I took 100mgs and got the most benefit versus side effects. If I went any higher my blood pressure dropped too low and I was too dizzy (even with splitting up my dosages). At 100mg, taken three times a day (3 pills, 4 pills three hours later, and 3 pills three hours after that), I felt great. The only other downside was my acne was incredibly terrible. It really got much worse on the higher dosage.
I would try maxing out the dose before augmenting. Then try just one augmentor at a time.
-Jessica
Posted by Ted Abel on October 22, 2002, at 19:56:28
In reply to Re: maoi augmentation, posted by jsarirose on October 22, 2002, at 19:07:31
Some people are rapid metabolizers of MAOI's, and need a larger dose. I know I needed three times the maximum dose the PDR mentions. My psych. informed me that some people, especially males of Nothern European descent, genetically reqiire larger doses. I had no response of MAOI's until I tried the large dose.
Posted by djmmm on October 23, 2002, at 23:44:03
In reply to maoi augmentation, posted by Ted Abel on October 19, 2002, at 13:17:12
why not try D-L Phenylalinine, or L-tyrosine..or try some atypical antiepileptics like Neurontin, Topamax, or Zonegran
Posted by Ted Abel on October 24, 2002, at 0:45:54
In reply to Re: maoi augmentation, posted by djmmm on October 23, 2002, at 23:44:03
> why not try D-L Phenylalinine, or L-tyrosine..or try some atypical antiepileptics like Neurontin, Topamax, or Zonegran
Are these all safe to add to a maoi? I heard that they might lead to an hypertensive crisis. I know many of the pre-cautions are really not serious concerns. These amino acids seem like that they may really contribute as precusors to building dopamine and serotonin, but I want to know they are safe absolutely before I experiment with them.Ted
Posted by djmmm on October 24, 2002, at 9:34:40
In reply to Re: maoi augmentation, posted by Ted Abel on October 24, 2002, at 0:45:54
well, I have always taken amino acid supplements (in powder form) along with Nardil...
L-Isoleucine 5,160 mg
L-Leucine 9,040 mg
L-Valine 5,380 mg
L-Lysine 7,740 mg
L-Methionine 1,870 mg
L-Phenylalanine 3,500 mg
L-Threonine 5,030 mg
L-Tryptophan 1,340 mg
L-Alanine 3,760 mg
L-Arginine 2,620 mg
L-Aspartic Acid 8,380 mg
L-Cystine 360 mg
L-Glutamic Acid 16,900 mg
L-Glycine 1,800 mg
L-Histidine 2,120 mg
L-Proline 6,750 mg
L-Serine 2,930 mg
L-Tyrosine 2,780 mgI dont have and problems, but I never have (with food, alcohol, etc)
This is the end of the thread.
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