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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 becksA on September 8, 2004, at 19:47:20
I read a few things about Nardil, and am seriously considering it as my SAD has gotten bad, and nothing else seems to be working. I have a few questions...
What is there about MAOI's that makes it have so many restrictions? In other words, what is stopping them from creating a med that does the same thing, without all these.
What about the side effects? Upon reading all the food interactions, I have the feeling that it's a very serious drug, leading me to also believe that at the beginning it has certain serious side effects. Is this the case? If so, what are most common...Some I cannot deal with.
What about the success rate? If I'm going to go and try this, I would hope it would be helpful to me, as nothing else has been in the past, and it is very discouraging.
Thanks
Posted by steve12 on September 8, 2004, at 20:15:38
In reply to Seriously considering MAOI's....please read, posted by becksA on September 8, 2004, at 19:47:20
MAOI's get a bad rap in the US. They are great for anxiety and have few side effects (like sexual side effects), but have one big drawback: if you eat certain foods, you can have a hypertensive crisis (but you can have emergency meds to counteract it). The foods include red wine, cheese, and fish. Recent research suggests that the food restrictions need not be as severe as once thought. Unfortuantely, it is unlikely that a "safe" MAOI will be made due to the unique mechanism in which they act (for a good oveview, see Julian, A Primer of Psychoactive Drugs). The real problem with MAOI's is finding a doc to prescribe them as they have a notorious reputation for the reasons listed above and they are ***generic*** and the drug companies don't fly the doc's out to Palm Springs for "educational conferences" ;)
> I read a few things about Nardil, and am seriously considering it as my SAD has gotten bad, and nothing else seems to be working. I have a few questions...
>
> What is there about MAOI's that makes it have so many restrictions? In other words, what is stopping them from creating a med that does the same thing, without all these.
>
> What about the side effects? Upon reading all the food interactions, I have the feeling that it's a very serious drug, leading me to also believe that at the beginning it has certain serious side effects. Is this the case? If so, what are most common...Some I cannot deal with.
>
> What about the success rate? If I'm going to go and try this, I would hope it would be helpful to me, as nothing else has been in the past, and it is very discouraging.
>
> Thanks
Posted by becksA on September 8, 2004, at 20:45:34
In reply to Re: Seriously considering MAOI's....please read, posted by steve12 on September 8, 2004, at 20:15:38
If I want to go this route, which I really do, simply because nothing else has worked AT ALL, which MAOI seems to be the most successful?
Thanks
Posted by maddog on September 8, 2004, at 22:05:15
In reply to Re: Seriously considering MAOI's....please read, posted by becksA on September 8, 2004, at 20:45:34
I have been on Nardil now for 4 weeks. My current dose is 60mg. So far I have had all of the typical side effects (sexual, insomnia, etc.) but the insomnia appears to be lessening.
I believe it is starting to have a calming effect both in terms of alleviating depression and reducing anxiety. However, I will likely move up to 75mgs in a week.
In terms of eating, I have not found that I need to change my diet very much. I have had pizza several times with no problem. That being said, my normal BP is 90/60.
In short, I am optimistic about Nardil for my depression, anxiety and social anxiety.
maddog
Posted by Ilene on September 8, 2004, at 22:14:10
In reply to Re: Seriously considering MAOI's....please read, posted by becksA on September 8, 2004, at 20:45:34
> If I want to go this route, which I really do, simply because nothing else has worked AT ALL, which MAOI seems to be the most successful?
>
> ThanksAFAIK, there are only three MAOIs available in the US, which is where I'm assuming you live. These are Nardil, Parnate, and Marplan. They're about the same in effectiveness. Parnate is more stimulating, Nardil is more sedating. I think weight gain can be an issue w/ Nardil. The food and drug restrictions are the same w/ all three.
I take Marplan. It seems to be working at 50 mg/day, unlike most of the other dozen or so drugs I've taken. I haven't noticed any sedation or stimulation. It lowers my blood pressure to the point where I get light-headed at times, and I've noticed a little edema in my feet and ankles lately. At this dosage I'm also getting a little dry mouth.There are times when I really, really miss eating cheese. That's the only dietary restriction that's a problem for me.
Posted by becksA on September 8, 2004, at 22:28:15
In reply to Re: Seriously considering MAOI's....please read, posted by Ilene on September 8, 2004, at 22:14:10
Aside all this, you didn't talk much about success...I assume this means you found it to work for you? maddog please keep me updated on how it works out for you.
Posted by maddog on September 8, 2004, at 23:16:39
In reply to Re: Seriously considering MAOI's....please read, posted by becksA on September 8, 2004, at 22:28:15
> Aside all this, you didn't talk much about success...I assume this means you found it to work for you? maddog please keep me updated on how it works out for you.
Gradually over the last 4 weeks I have felt my anxiety being reduced. I don't have as many racing thoughts and I am more comfortable around people. My recent depression has lifted. I feel like strolling instead of always rushing.Nardil takes time to take effect to I expect the reduction to continue. In addition, I will likely increase my dosage to 75mgs which is more in line with my weight (85kgs).
Check back with me in 2-3 weeks and I will give you an update. By then I expect that Nardil will have taken more full effect.
maddog
Posted by King Vultan on September 9, 2004, at 9:02:27
In reply to Re: Seriously considering MAOI's....please read, posted by steve12 on September 8, 2004, at 20:15:38
> MAOI's get a bad rap in the US. They are great for anxiety and have few side effects (like sexual side effects), but have one big drawback: if you eat certain foods, you can have a hypertensive crisis (but you can have emergency meds to counteract it). The foods include red wine, cheese, and fish. Recent research suggests that the food restrictions need not be as severe as once thought. Unfortuantely, it is unlikely that a "safe" MAOI will be made due to the unique mechanism in which they act (for a good oveview, see Julian, A Primer of Psychoactive Drugs). The real problem with MAOI's is finding a doc to prescribe them as they have a notorious reputation for the reasons listed above and they are ***generic*** and the drug companies don't fly the doc's out to Palm Springs for "educational conferences" ;)
>
>
>
Red wine is now thought to be okay with MAOIs, at least in moderation. The prohibition came about because of a very high level of tyramine (the problematic substance) found in a sample of Chianti wine in 1964. More recent studies have failed to reproduce these results; although, it is important to note that both wine and beer do contain some amount of tyramine. The modern recommendation is no more than 2 bottled beers or glasses of wine per day; however, tap beer is absolutely prohibited due to very high tyramine levels detected in more than one instance. There is also at least one case report of a Nardil patient suffering a hypertensive episode after drinking tap beer.Fresh fish is okay for MAOI users, and even though pickled herring is on many of the lists, two different studies from the 80's found very low levels of tyramine in pickled herring. Many cheeses are actually okay; the bad ones are the highly aged cheeses like cheddar and blue cheese. I take Parnate and personally avoid all cheeses except American, mozzarella, and parmesan, but there are other cheeses I could consume if I really wanted to. It is important for MAOI patients to avoid any food that is old or of questionable freshness--liver would be a good example. The reason it appears on some of the lists appears to be due to some case reports from the 60's involving MAOI patients suffering hypertensive crises from liver that had been improperly stored. It is also a good idea to avoid foods like yogurt that are close to the expiration date.
As for the generic issue, neither Nardil nor Parnate are actually generic, at least in the US, as the volume of their sales is so small that the generic companies don't appear to have much of a interest. Nardil comes from the Parke-Davis division of Pfizer, and Parnate is made by GlaxoSmithKlineBeecham. Hence, Glaxo is able to charge a pretty good buck for Parnate at over $100/month for 4 x 10 mg/day.
Todd
Posted by steve12 on September 9, 2004, at 15:23:35
In reply to Re: Seriously considering MAOI's....please read, posted by becksA on September 8, 2004, at 20:45:34
I heard the best sucess with Parnate. The other posting is correct -- the MAOI are not generic in the US, but are not as profitable as the SSRI's.
> If I want to go this route, which I really do, simply because nothing else has worked AT ALL, which MAOI seems to be the most successful?
>
> Thanks
This is the end of the thread.
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