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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 16 of 16. This is the beginning of the thread.
Posted by platinumbride on December 19, 2005, at 11:41:59
Hi all,
I have finally found a doctor who isn't afraid to treat depression aggressively. I have an appt. coming up in a few weeks. On the phone we discussed maois.
I have read a lot of posts about them here. I see that nardil is better for people with anxiety issues (me), but parnate is better for motivation issues (me also).
I have read that nardil causes weight gain in many cases while parnate is less likely to.
I am a 5'2 female weighing in at 208, so my weight gain fears are not frivolous. I'm in my early 30s and getting a lot of problems that obese people get : (
But I am also terrified of MORE anxiety, which is barely kept in check with klonopin and neurontin.
I feel as if my anxiety calls for nardil but my weight and amotivation call for parnate....
I feel inclined to try parnate - maybe it's just a silly gut feeling, but I am scared. Are my fears founded?
Any chance that I won't be at 300 lbs if I try nardil?
Or maybe I need to look at marplan. Anyone here want to vouch for it? I haven't seen anything great about it posted.
And what do people on maois with bad sinus conditions do without sudafed???
Thanks a bunch,
Diane
4800 mgs neurontin
4mgs klonpin
900 mgs lithium
1000 mgs metformin
sudafed every day
allegra
tramadol or vicodin when I am self-medicating because I need to find motivation to get to the grocery store or clean my apartment : (
Posted by gardenergirl on December 19, 2005, at 17:52:17
In reply to maoi questions, posted by platinumbride on December 19, 2005, at 11:41:59
Hi,
I've never tried Parnate. I'm doing well on Nardil, but I did gain about 45 pounds in the last two years now. (Sheesh, has it been that long?) That's the worst part of it, IMO. Other side effects are easier to deal with. So I do think your concern is valid.I don't know how well Parnate does with anxiety. I know Nardil has helped mine. I didn't even realize that anxiety was a big thing for me until some of it lessened, and I felt more confident.
Regarding sinus issues, that is a difficult thing. I had to switch from Claritin-D to just plain Claritin. Actually, I don't take any allergy stuff now.
One thing I do when I have a bad head cold is to try to use menthol stuff and steam. There's even a new thing out there that dissolves in the shower and sends out mentholated (think Vicks) steam into the air. I also keep mint oil handy, and breathe that in. Eating hot and spicy foods as tolerated can help, staying hydrated, etc.
And I always get a flu shot and try to practice extra diligent hand-washing during cold seasons.
Good luck!
gg
Posted by Phillipa on December 19, 2005, at 20:02:16
In reply to Re: maoi questions » platinumbride, posted by gardenergirl on December 19, 2005, at 17:52:17
gg sometime I would love to hear the meds you tried before you took nardil. And willyee is a parnate user. Fondly, Phillipa
Posted by RobertDavid on December 19, 2005, at 21:01:58
In reply to maoi questions, posted by platinumbride on December 19, 2005, at 11:41:59
I took Lyrica for a short time and gained weight on it. I wonder how much that may be affecting your current weight. It didn't help me for my anxiety, the klonopin does. You're taking a pretty stong dose of klonopin now and if that's not working, an MAOI would be a good option for the anxiety, but I understand your concern about the weight.
Though I haven't taken an MAOI yet, I plan to add it to klonopin once EMSAM is approved (should get approved by end of February). It's an MAOI that will be delivered via a patch which I understand will limit the food problem and have a much lower side affect profile including less weight gain.
I have been ready to start Nardil for help with both anxiety and mild depression, but my doctor (who is currently writing the perscribing info for EMSAM) has suggested I wait a bit longer and try it first befor Nardil.
Anyway, something to think about.
Posted by Tomatheus on December 19, 2005, at 21:03:32
In reply to maoi questions, posted by platinumbride on December 19, 2005, at 11:41:59
Platinumbride,
Based on your post, it seems to me that the decision between Nardil and Parnate is basically a toss-up in your case. As you mentioned, Nardil tends to be better for anxiety, Parnate tends to be a little better for motivation issues, and Nardil tends to lead to more weight gain. So, in your case, I wouldn't say that there's an obvious choice one way or the other. I think it's also important to remember that MAOIs, like all drugs, sometimes work differently in reality than they're supposed to "on paper," and they also have different effects on different people. As effective as Nardil (for example) tends to be for depression (especially "atypical" depression) and anxiety, some depressed and anxious patients do not repond very well to Nardil. There is also a significantly sized group of patients who responded remarkably well to Nardil for decades and then became disabled by their depression and anxiety when Pfizer changed the medication's formulation two years ago. And finally, even though Parnate is typically thought of as being activating, some patients find it incredibly sedating, especially in the afternoon. So, given the complexity of the situation, I think it might just be a matter of picking one of the two drugs, giving it a full trial, and then switching to the other MAOI if you're not satisfied with it. I wish I could suggest something more definitive, but in reality, I don't think it's possible to make a clear determination as to which drug would be better for you.
Also, I have a slight suspicion that your current medications might be at least partially causing the anxiety and motivation problems that you've been experiencing. Before you started taking medications, did you have the same anxiety and motivation issues that you have now? If not, I think it's possible that the lithium might be triggering your anxiety and that the Neurontin and Klonopin could be contributing to some of your motivation problems. From my personal experience, I can say that anxiety was never much of a problem for me before I started taking meds (and during most med trials), but I sometimes felt unbearably anxious when I was on lithium. So, while I'm not necessarily saying that your anxiety and motivation issues are being caused *completely* by the meds that you're taking, I think you and your doctor need to examine whether or not it might be a good idea to change your current med regime to try to alleviate your anxiety and motivational symptoms.
Tomatheus
> Hi all,
>
> I have finally found a doctor who isn't afraid to treat depression aggressively. I have an appt. coming up in a few weeks. On the phone we discussed maois.
>
> I have read a lot of posts about them here. I see that nardil is better for people with anxiety issues (me), but parnate is better for motivation issues (me also).
>
> I have read that nardil causes weight gain in many cases while parnate is less likely to.
>
> I am a 5'2 female weighing in at 208, so my weight gain fears are not frivolous. I'm in my early 30s and getting a lot of problems that obese people get : (
>
> But I am also terrified of MORE anxiety, which is barely kept in check with klonopin and neurontin.
>
> I feel as if my anxiety calls for nardil but my weight and amotivation call for parnate....
>
> I feel inclined to try parnate - maybe it's just a silly gut feeling, but I am scared. Are my fears founded?
>
> Any chance that I won't be at 300 lbs if I try nardil?
>
> Or maybe I need to look at marplan. Anyone here want to vouch for it? I haven't seen anything great about it posted.
>
> And what do people on maois with bad sinus conditions do without sudafed???
>
> Thanks a bunch,
>
> Diane
>
> 4800 mgs neurontin
> 4mgs klonpin
> 900 mgs lithium
> 1000 mgs metformin
> sudafed every day
> allegra
> tramadol or vicodin when I am self-medicating because I need to find motivation to get to the grocery store or clean my apartment : (
Posted by gardenergirl on December 19, 2005, at 22:27:21
In reply to Re: maoi questions » gardenergirl, posted by Phillipa on December 19, 2005, at 20:02:16
> gg sometime I would love to hear the meds you tried before you took nardil. And willyee is a parnate user. Fondly, Phillipa
Zoloft a few times
Sarafem
Celexa
Celexa with Wellbutrin
and then NardilOnce I got my diagnosis of atypical depression, I wanted to go for the "gold standard" instead of doing more trials of stuff. SSRI's did nothing for me. Never tried any tricyclics. It helped that I had a GP who agreed and that my pdoc didn't put me through a bunch of trials before agreeing to keep me on the Nardil.
gg
Posted by platinumbride on December 20, 2005, at 9:03:03
In reply to Re: maoi questions » platinumbride, posted by Tomatheus on December 19, 2005, at 21:03:32
Thank you all for your help.
It's funny: lithium helped so much for depression for several months and then....nothing. But I don't think it triggered anxiety.
As for neurontin and klonopin, I am sure that they contribute to lack of motivation. But anxiety, until it became uncontrollable, often WAS my motivation. It wasn't fun, but it usually helped get things done.
Perhaps I will wind up being advised to trade the neurontin weight gain for nardil weight gain!!!
There are a lot of side effects that I will live with.....weight gain and anxiety, unfortunately, are two that I prefer not to!
Guess it will just be a crap shoot
Diane
Posted by Declan on December 20, 2005, at 20:20:33
In reply to Re: maoi questions » platinumbride, posted by Tomatheus on December 19, 2005, at 21:03:32
I suspect, but don't know, that if you've been taking Sudafed forever then you should be able to take minimal doses with a MAOI. I did with Parnate anyway. For my sinus condition I also used antiallergy herbs, steroid spray, antihistamine spray, vitamin C, Xylotol spray, and neti pot (nasal douche), which more or less kept it in check. My IGE is up and a lot of things (including pharmaceuticals) make me react. It's a drag, isn't it?
Declan
Posted by platinumbride on December 22, 2005, at 9:28:36
In reply to Re: maoi questions, posted by Declan on December 20, 2005, at 20:20:33
Thanks for that info...
What is IGE?
> I suspect, but don't know, that if you've been taking Sudafed forever then you should be able to take minimal doses with a MAOI. I did with Parnate anyway. For my sinus condition I also used antiallergy herbs, steroid spray, antihistamine spray, vitamin C, Xylotol spray, and neti pot (nasal douche), which more or less kept it in check. My IGE is up and a lot of things (including pharmaceuticals) make me react. It's a drag, isn't it?
> Declan
Posted by Declan on December 22, 2005, at 19:39:20
In reply to Re: maoi questions, posted by platinumbride on December 22, 2005, at 9:28:36
IgE stands for Immunoglobulin E, which is a marker of reactivity. There are others, I forget their names. They indicate different things about the allergic process. Mine should be under 50 and is over 800.
Declan
Posted by strugglingsteve on December 23, 2005, at 0:05:08
In reply to Re: maoi questions, posted by Declan on December 22, 2005, at 19:39:20
I am very new to nardil having only been on it for two weeks. What I can tell you is that my disabling anxiety and agitation has really calmed down alot and it took about 10 days for that to happen at 45 mg. I am starting to slowly gain weight and am worried about that but hoping the rate will slow down and the med will kick in so I will start exercising again. I was using ativan to slow the craziness down but havent taken any of that or any neurontin since Sunday and am pretty amazed actually. If it can do as well with the depression then I am going to have found my treatment finally. I have no other side effects to report at 45 mg.
Posted by Declan on December 23, 2005, at 3:22:53
In reply to Re: maoi questions » Declan, posted by strugglingsteve on December 23, 2005, at 0:05:08
Well that sounds absolutely great. An AD only has to be a bit good. Lower dose Nardil is a lovely idea.
Declan
Posted by Jedi on December 24, 2005, at 5:24:39
In reply to Re: maoi questions, posted by Declan on December 20, 2005, at 20:20:33
> I suspect, but don't know, that if you've been taking Sudafed forever then you should be able to take minimal doses with a MAOI. I did with Parnate anyway. For my sinus condition I also used antiallergy herbs, steroid spray, antihistamine spray, vitamin C, Xylotol spray, and neti pot (nasal douche), which more or less kept it in check. My IGE is up and a lot of things (including pharmaceuticals) make me react. It's a drag, isn't it?
> DeclanHi,
Sounds like you may have gotten lucky, but pseudophedrine HCL (Sudafed) is a definite No-NO with MAOIs. It's one of the fastest ways to end up in the ER. You really have to watch your cold and allergy meds close on MAOIs. There are very few over-the-counter cold meds that can be taken safely. Diphenhydramine HCL (Benadryl) is safe as long as it's not mixed with anything else. I've also had good luck with the nasal cortisone sprays such as Flonase.Tramadol (Ultram) is an opioid that increases serotonin and norepinephrine in the brain. The possibility of serotonin syndrome exists when it is used with the MAOIs.
Take care,
Jedi
Posted by platinumbride on December 29, 2005, at 9:31:37
In reply to Re: maoi questions » Declan, posted by Jedi on December 24, 2005, at 5:24:39
Thanks, Jedi...
We will have to see about the sudafed. As it is now, I have still a few weeks to wait before I see this new doctor. Flonase has never done much for me, but I know there are other options in that arena.As for tramadol or vicodin, I only take them now in order to get a little relief - if only for a short while. I am seeing this other doc in the hopes that I won't be needing that kind of stuff to self-medicate with in the future.
Thanks again to everyone....
Diane
> > I suspect, but don't know, that if you've been taking Sudafed forever then you should be able to take minimal doses with a MAOI. I did with Parnate anyway. For my sinus condition I also used antiallergy herbs, steroid spray, antihistamine spray, vitamin C, Xylotol spray, and neti pot (nasal douche), which more or less kept it in check. My IGE is up and a lot of things (including pharmaceuticals) make me react. It's a drag, isn't it?
> > Declan
>
> Hi,
> Sounds like you may have gotten lucky, but pseudophedrine HCL (Sudafed) is a definite No-NO with MAOIs. It's one of the fastest ways to end up in the ER. You really have to watch your cold and allergy meds close on MAOIs. There are very few over-the-counter cold meds that can be taken safely. Diphenhydramine HCL (Benadryl) is safe as long as it's not mixed with anything else. I've also had good luck with the nasal cortisone sprays such as Flonase.
>
> Tramadol (Ultram) is an opioid that increases serotonin and norepinephrine in the brain. The possibility of serotonin syndrome exists when it is used with the MAOIs.
>
> Take care,
> Jedi
Posted by Jedi on December 30, 2005, at 3:32:18
In reply to Re: maoi questions, posted by platinumbride on December 29, 2005, at 9:31:37
Hi Diane,
One time I made the mistake of telling my PDOC that I was trying some tramadol, while I waited for him to figure out what he was doing. The guy about flipped. He kept taking my money, but he never did another positive thing for me. I found another Doctor.
Much Luck,
Jedi
> Thanks, Jedi...
> We will have to see about the sudafed. ... >
> > > I suspect, but don't know, that if you've been taking Sudafed forever then you should be able to take minimal doses with a MAOI. I did with Parnate anyway. ...
> > Hi,
> > Sounds like you may have gotten lucky, but pseudophedrine HCL (Sudafed) is a definite No-NO with MAOIs. It's one of the fastest ways to end up in the ER. ...>
>
Posted by platinumbride on December 30, 2005, at 14:46:10
In reply to Re: maoi questions » platinumbride, posted by Jedi on December 30, 2005, at 3:32:18
Jedi,
I read your post with a bit of a smirtk...
I had a similar experience. He was mostly pissed that I was doing it without ever having told him. He even said or alluded to not really wanting to deal with addiction issues in his practice. That was back in June. Since nothing he has done since has helped me, I have no choice but to find someone else.Sigh...it can't be easy having treatment resistant patients, but then again, if you are committed to a patient's well-being and you see that they aren't getting any better, it just might be a good idea to think outside of the ssri/snri, new genration drug box.
Thanks again,
Diane
> Hi Diane,
> One time I made the mistake of telling my PDOC that I was trying some tramadol, while I waited for him to figure out what he was doing. The guy about flipped. He kept taking my money, but he never did another positive thing for me. I found another Doctor.
> Much Luck,
This is the end of the thread.
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