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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by mbailey on January 27, 2004, at 8:58:54
After reading some more threads here and on the internet,
I realized that it is not unusual for people to
be on a drug, have it work and then have it poop
out. My husband has gone thru this a few times
and we are always surprised.Okay -here is the question. After reading posts
from the Nardil Princess and Nardil King, I
find myself wondering - if my husband was on
Parnate, it worked for a while, then stopped (he
has just come off it), is Nardil something to
look into? Or if one MAOI stops working, does
that mean MAOIs in general just wont work?
Thanks,
Jean
Posted by Maxime on January 27, 2004, at 10:56:48
In reply to Possible? To Nardil from Parnate?, posted by mbailey on January 27, 2004, at 8:58:54
Hi Jean. People switch all the time. I take Parnate myself. But I know of people who have switch from one to another. For some reason when one doesn't work the other does (in most cases).
Also, make sure your hubby was on a high enough dose of the Parnate. The PDR says 60 mg is the max but I take 90 mg and I know some people take up to 120 mg .... especially for treatment resistent depression.
Some people have switched right over while others give their bodies a 2 week wash out period. I don't know however if that is necessary.
Maxime
> After reading some more threads here and on the internet,
> I realized that it is not unusual for people to
> be on a drug, have it work and then have it poop
> out. My husband has gone thru this a few times
> and we are always surprised.
>
> Okay -here is the question. After reading posts
> from the Nardil Princess and Nardil King, I
> find myself wondering - if my husband was on
> Parnate, it worked for a while, then stopped (he
> has just come off it), is Nardil something to
> look into? Or if one MAOI stops working, does
> that mean MAOIs in general just wont work?
>
>
> Thanks,
> Jean
>
Posted by cosis on January 27, 2004, at 12:40:03
In reply to Possible? To Nardil from Parnate?, posted by mbailey on January 27, 2004, at 8:58:54
> After reading some more threads here and on the internet,
> I realized that it is not unusual for people to
> be on a drug, have it work and then have it poop
> out. My husband has gone thru this a few times
> and we are always surprised.
>
> Okay -here is the question. After reading posts
> from the Nardil Princess and Nardil King, I
> find myself wondering - if my husband was on
> Parnate, it worked for a while, then stopped (he
> has just come off it), is Nardil something to
> look into? Or if one MAOI stops working, does
> that mean MAOIs in general just wont work?
>
>
> Thanks,
> Jean
>
Hi - When it stopped working did he try to adjust the dosage? When Nardil wasn't being as effective for me I needed to raise the dosage by 15mg and that did the trick.....
Posted by mbailey on January 27, 2004, at 12:47:53
In reply to Re: Possible? To Nardil from Parnate?, posted by cosis on January 27, 2004, at 12:40:03
The doc would only go to 60 on parnate.
Posted by cosis on January 27, 2004, at 16:35:06
In reply to Re: Possible? To Nardil from Parnate?, posted by mbailey on January 27, 2004, at 12:47:53
> The doc would only go to 60 on parnate.
oh yeah thats a pretty high dose
Posted by Maxime on January 27, 2004, at 17:41:35
In reply to Re: Possible? To Nardil from Parnate?, posted by mbailey on January 27, 2004, at 12:47:53
That's too bad because there is a lot of literature out there that says it's necessary to go above that with treatment resistent depression which is probably what hubby has since meds poop out on him.
Maxime
> The doc would only go to 60 on parnate.
Posted by missliz on January 29, 2004, at 2:17:03
In reply to Re: Possible? To Nardil from Parnate?, posted by Maxime on January 27, 2004, at 17:41:35
A lot of people need more than 60 mg- which blows my mind, because I was booming on 30 mg. Parnate doesn't "poop out". The stuff is basicly methamphetamine, with a few other choice metabolites. It works- you just need enough of it. There's a bonafide problem of undermedication of deppressive illness in this country- it's 'cause the PDR is written by company lawyers. What people on this board call poop out is usually just time to titrate the dose up again but the bottom of the class people who get shunted into psych won't do it. May I suggest a second opinion? Or a new doctor?
If he switches, he needs to taper the dose down for a few weeks and then do the two weeks. The chemistry is too tedious to write out- but there is any ruler of the MAOI it's me. The washout is very important. Gruesome, but better than stroking out.
Parnate is manufactured from amphetamine; Nardil is made from antibiotics, which were the original MAOIs. It's gentler, causes weight gain in some people, I LOVED it. So good to be normal! Drank gallons of coffee on it, but I was in grad school a lot of that time. The lifestyle.
I think a higher dose deserves a chance- or, here's a cool trick, you can goose an MAOI with lithium and see if that gets it moving. I reccomend Lithobid over the generic, a small dose should do it. Do not under any circumstanses take a diuretic with this combo- Parnate and thiazide diuretics are potentially lethal. Bet nobody knew that, did you? ;D Neither does your shrink- it isn't in the PDR, but it's in the formularies of every other nation in the first world.
If the shrink doesn't know any of this, he's in over his head and you need a real psychopharmacologist. MAOIs are the big leagues of treatment, and depression that severe needs a doc who knows what he's doing.
Is he on anything else?
This is all meant to be tried under the supervision of a pdoc who knows what they're doing, of course, but there are more things to try with the Parnate. Good luck.Lizzy
Posted by djmmm on January 29, 2004, at 17:38:21
In reply to NO! you need to taper and washout!, posted by missliz on January 29, 2004, at 2:17:03
> A lot of people need more than 60 mg- which blows my mind, because I was booming on 30 mg. Parnate doesn't "poop out". The stuff is basicly methamphetamine, with a few other choice metabolites.
--that just isn't true, you are confusing the MAO-B inhibitor Deprenyl, which has amphetamine metabolites. Parnate is structurally similar to amphetamine, it is not derived from or metabolized into any form of amphetamine. It is simply similar in chemical structure...example: Effexor is a phenylalanine, as is the street drug Ecstacy...similar..but VERY different.
It works- you just need enough of it. There's a bonafide problem of undermedication of deppressive illness in this country- it's 'cause the PDR is written by company lawyers. What people on this board call poop out is usually just time to titrate the dose up again but the bottom of the class people who get shunted into psych won't do it. May I suggest a second opinion? Or a new doctor?
> If he switches, he needs to taper the dose down for a few weeks and then do the two weeks. The chemistry is too tedious to write out- but there is any ruler of the MAOI it's me. The washout is very important. Gruesome, but better than stroking out.-- A wash out of 2 weeks is not necessary form Parnate to Nardil, a short washout is recomended when switching from Nardil to Parnate, but only because Nardil is an irreversible MAOI, and accumulates in the liver.
> Parnate is manufactured from amphetamine; Nardil is made from antibiotics, which were the original MAOIs.
-- Wrong, I'm sorry, Nardil is a hydrazine derivative, it has nothing to do with antibiotics, hydrazine is actually rocket fuel. MAOI activity was originally discovered via the use of anti-malaria meds.
It's gentler, causes weight gain in some people, I LOVED it. So good to be normal! Drank gallons of coffee on it, but I was in grad school a lot of that time. The lifestyle.
> I think a higher dose deserves a chance- or, here's a cool trick, you can goose an MAOI with lithium and see if that gets it moving. I reccomend Lithobid over the generic, a small dose should do it. Do not under any circumstanses take a diuretic with this combo- Parnate and thiazide diuretics are potentially lethal. Bet nobody knew that, did you? ;D Neither does your shrink- it isn't in the PDR, but it's in the formularies of every other nation in the first world.--it does state in the PDR not to combine thiazides with MAOIs
> If the shrink doesn't know any of this, he's in over his head and you need a real psychopharmacologist. MAOIs are the big leagues of treatment, and depression that severe needs a doc who knows what he's doing.
> Is he on anything else?
> This is all meant to be tried under the supervision of a pdoc who knows what they're doing, of course, but there are more things to try with the Parnate. Good luck.
>
> Lizzy--With all due respect, Where on earth did you hear all of this false info on MAOIs??
Posted by rod on January 30, 2004, at 4:25:27
In reply to Re: NO! you need to taper and washout!, posted by djmmm on January 29, 2004, at 17:38:21
> > ..example: Effexor is a phenylalanine, as is the street drug Ecstacy...similar..but VERY different.
Effexor is a phenylethylamine, not phenylalanine.
> -- A wash out of 2 weeks is not necessary form Parnate to Nardil, a short washout is recomended when switching from Nardil to Parnate, but only because Nardil is an irreversible MAOI, and accumulates in the liver.You once wrote, that you can reduce nardil to 30mg because it accumulates in the liver. I dont understand this. Could you explain it to me? Douesnt that mean there is also a drop in the blood level? Just because it accumulates in the liver isnt there just a longer time to reach a steady blood concentration?
thanks.Roland
Posted by Questionmark on January 30, 2004, at 15:05:16
In reply to NO! you need to taper and washout!, posted by missliz on January 29, 2004, at 2:17:03
> A lot of people need more than 60 mg- which blows my mind, because I was booming on 30 mg. Parnate doesn't "poop out". The stuff is basicly methamphetamine, with a few other choice metabolites.
It is NOT basically methamphetamine. It IS often quite stimulating, but it is NOT an amphetamine nor have its metabolite(s) been found to be (an) amphetamine(s).
> It works- you just need enough of it. There's a bonafide problem of undermedication of deppressive illness in this country- it's 'cause the PDR is written by company lawyers. What people on this board call poop out is usually just time to titrate the dose up again but the bottom of the class people who get shunted into psych won't do it. May I suggest a second opinion? Or a new doctor?
"Poop-out" as i'm aware of the slang, is just a layman's term for "tolerance." Therefore even if it's just time to titrate the dose up again it is *still* poop-out. One has built up a tolerance to the present dose and needs to either increase the dose or swich meds. However, increases the dosage of a drug too often and/or too much can just create a cyclical problem of dependence. So it's not always just an obvious smart move to increase one's dose of something when s/he has built a tolerance to it. It depends on a variety of factors.
> If he switches, he needs to taper the dose down for a few weeks and then do the two weeks. The chemistry is too tedious to write out- but there is any ruler of the MAOI it's me. The washout is very important. Gruesome, but better than stroking out.
That is what is typically maintained. But depending on the time on and the dosage, i believe it's much safer to go from Parnate to Nardil than vice versa, and therefore not always necessary to wait 2 weeks before doing so. A smart dr. should know a reasonable timeline for this. From my own experience, Parnate is MUCH more likely to cause a hypertensive reaction than Nardil is. So, yeah. But then again it's better safe than sorry. It just depends. i almost never like these "carved in stone" type of psychiatric standards.
> Parnate is manufactured from amphetamine; Nardil is made from antibiotics, which were the original MAOIs. It's gentler, causes weight gain in some people, I LOVED it. So good to be normal! Drank gallons of coffee on it, but I was in grad school a lot of that time. The lifestyle.
i'm sorry, but do you have any proof to back up that first sentence of this paragraph? (i do agree with that rest of the paragraph though-- in most cases). i've never heard that Parnate was manufactured from amphetamine or Nardil from an antibiotic. i guess it's possible. But if you're referring to the first MAOI that was being used for something other than depression and was later found that it was alleviating many of the patients' depressions, that was specifically tuberculosis it was being used for (i'm pretty sure). But that doesn't mean that the subsequent hydrazine MAOIs (e.g. Nardil) are synthesized from that original MAOI or any other antibiotic. Sorry to be a technical a-hole, just wanted to clear that up.
> I think a higher dose deserves a chance- or, here's a cool trick, you can goose an MAOI with lithium and see if that gets it moving. I reccomend Lithobid over the generic, a small dose should do it. Do not under any circumstanses take a diuretic with this combo- Parnate and thiazide diuretics are potentially lethal. Bet nobody knew that, did you? ;D Neither does your shrink- it isn't in the PDR, but it's in the formularies of every other nation in the first world.
Thats interesting. i wonder why that is. i didnt know about that.
> If the shrink doesn't know any of this, he's in over his head and you need a real psychopharmacologist. MAOIs are the big leagues of treatment, and depression that severe needs a doc who knows what he's doing.
Pdocs need to freaking educate themselves about MAOIs to an adequate level and stop relying on the g.d. pharmaeutical companies to supply them with most of their new freaking information!! AH it drives me NUTS how incompetent psychiatrists are, espECially with MAOIs! A:Lhf!! (anger not toward you. just brought it up in me).
> Is he on anything else?
> This is all meant to be tried under the supervision of a pdoc who knows what they're doing, of course, but there are more things to try with the Parnate. Good luck.
>
> Lizzy
Posted by djmmm on January 30, 2004, at 21:42:34
In reply to Re: NO! you need to taper and washout! » djmmm, posted by rod on January 30, 2004, at 4:25:27
> > > ..example: Effexor is a phenylalanine, as is the street drug Ecstacy...similar..but VERY different.
>
> Effexor is a phenylethylamine, not phenylalanine.
>
>
> > -- A wash out of 2 weeks is not necessary form Parnate to Nardil, a short washout is recomended when switching from Nardil to Parnate, but only because Nardil is an irreversible MAOI, and accumulates in the liver.
>
> You once wrote, that you can reduce nardil to 30mg because it accumulates in the liver. I dont understand this. Could you explain it to me?--sure thing, Phenelzine (Nardil) is a hydrazine deravitive, and hydrazine type drugs tend to accumulate (saturate) liver enzymes over time. If you take Nardil for an extended period of time, or at very high doses, you run the risk of hepatic injury (necrotizing hepatocellular damage)
Douesnt that mean there is also a drop in the blood level? Just because it accumulates in the liver isnt there just a longer time to reach a steady blood concentration?
-- When I suggested that you can decrease the dosage, this is independent of its concentration in whole blood...-- Nardil forms an irreversible covalent bond to monoamine oxidase (throughout the body), unlike Parnate (for example) you can decrease the dose because it takes a specific amount of time for your body to re-synthesize MAO...say for example, you were taking 60mg, and after 3 months, you felt nearly "recovered" You could then decrease the dosage to as little as 15mg 3x a week because of drug accumulation and the amount of time it takes your body (personally) to resynthesize MAO.
> thanks.
>
> Roland
>
>
>
This is the end of the thread.
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