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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by nickguy on May 14, 2006, at 16:16:13
No meds have helped me in the past, and so I just kind of gave up on them. But I figure that if I'm going to give up on meds altogether and just do CBT, I shuold atleast give an MAOI a shot before doing this. Anyway, Here are the meds my psychiatrist has already prescribed me and didn't work out.
paxil- effexor -cymbalta- lithium- lamictal- gabitril- lexapro -provigil -klonopin -wellbutrin -
I know that psychiatrists are by no means relaxed about prescribing maoi's. I know they like to try all the other ones first. So my question is, what else would he prescribe me before letting me try an maoi.
Posted by Emily Elizabeth on May 14, 2006, at 17:57:23
In reply to what else could my doc prescribe after these?, posted by nickguy on May 14, 2006, at 16:16:13
Posted by nickguy on May 14, 2006, at 19:05:41
In reply to What is your diagnosis? (nm), posted by Emily Elizabeth on May 14, 2006, at 17:57:23
I have social anxiety disorder and depression.
Posted by Racer on May 14, 2006, at 19:39:59
In reply to what else could my doc prescribe after these?, posted by nickguy on May 14, 2006, at 16:16:13
There are a whole host of things I see that could be helpful:
Remeron, nortriptyline, one of the other SSRIs, desipramine, and a number of combos.
If you're determined that an MAOI is what you want to try, your pdoc may indeed go ahead and prescribe it, and there's the new patch, too, which will probably make that an easier drug to get. Before doing that, print out a copy of the dietary restrictions, and stick to it for a few weeks -- see if it's something that you're willing to deal with indefinitely.
That's what stops me every time -- well, that and my T, who won't support taking any drug that requires any dietary restrictions for me ;-) -- I can see following the diet for a couple of months. But the idea of giving up so many of the limited number of foods that I eat comfortably doesn't bode well for an MAOI being a longer term solution for me.
What has your psychiatrist said when you're asked about other options?
Posted by nickguy on May 14, 2006, at 21:20:50
In reply to Re: what else could my doc prescribe after these?, posted by Racer on May 14, 2006, at 19:39:59
I mentioned maoi's, and he said he wanted to see if gabitril would help with anxiety before trying an maoi. He's hesitant about maoi's. I don't mind the diet restrictions though, the only one that would bother me is american cheese, which I hear isn't too risky. he thinks it's pretty clear that ssri's or snri's arent going to help me.
Posted by Phillipa on May 14, 2006, at 22:23:07
In reply to Re: what else could my doc prescribe after these?, posted by nickguy on May 14, 2006, at 21:20:50
I thought there were no dietary restrictions before you went above 6mg/20mg patch? Love Phillipa
Posted by gibber on May 15, 2006, at 0:57:57
In reply to Re: what else could my doc prescribe after these?, posted by Phillipa on May 14, 2006, at 22:23:07
There are no dietary restrictions for the patch below 6mg, but they're considering other MAOIs as well. American Cheese should be ok.
Posted by jedi on May 15, 2006, at 1:41:11
In reply to what else could my doc prescribe after these?, posted by nickguy on May 14, 2006, at 16:16:13
Hi,
From the number of meds taken you will probably be described as treatment resistant. Many PDOCs will want to have an adequate trial of a TCA before going to MAOIs. If your depression is atypical, which is of course more typical than the name implys, then a MAOI would seem to be the medication of choice. Nardil was the only med that brought me out of major depression. This is out of probably thirty drug combinations to this point. IMHO, if your depression is atypical, a MAOI is the logical choice and has the best chance of working.
Good Luck,
Jedi> No meds have helped me in the past, and so I just kind of gave up on them. But I figure that if I'm going to give up on meds altogether and just do CBT, I shuold atleast give an MAOI a shot before doing this. Anyway, Here are the meds my psychiatrist has already prescribed me and didn't work out.
>
> paxil- effexor -cymbalta- lithium- lamictal- gabitril- lexapro -provigil -klonopin -wellbutrin -
>
>
> I know that psychiatrists are by no means relaxed about prescribing maoi's. I know they like to try all the other ones first. So my question is, what else would he prescribe me before letting me try an maoi.
>
>
Posted by JaclinHyde on May 15, 2006, at 12:01:27
In reply to Re: what else could my doc prescribe after these?, posted by nickguy on May 14, 2006, at 21:20:50
Take it from Ms experienced when it comes to the MAOI's, american cheese is just fine. Pretty much any processed cheese is fine; it is the aged stuff that you have to worry about. Pizza is ok too.
Racer I know what you mean about the dietary restrictions being a pain in the *ss BUT which would you rather have.....depression and anxiety or cheddar cheese? I mean when you think about it is the loss of these small number of foods really that big of a deal if you can feel well again? I remember going to Taco Bell once and felt a little sorry for myself because I couldn't put cheddar cheese on my taco. But then I had to laugh because I was actually AT Taco Bell when a month before that I couldn't leave my house due to paralizing panic attacks! I gladly and gratefully had my taco plain ;-)
JH
Posted by Racer on May 15, 2006, at 12:29:04
In reply to Re: what else could my doc prescribe after these?, posted by JaclinHyde on May 15, 2006, at 12:01:27
>
> Racer I know what you mean about the dietary restrictions being a pain in the *ss BUT which would you rather have.....depression and anxiety or cheddar cheese? I mean when you think about it is the loss of these small number of foods really that big of a deal if you can feel well again?Thanks, Jaclin, but there's a little more to it: I already don't eat a lot of things, which is part of my anorexia. Whenever I think about going on an MAOI, part of what's on my mind is that it would make it so much easier to restrict my eating, and thus lose weight. My T knows this, and has already said that she's against the idea of me trying an MAOI, which I'm sure she's already discussed with my pdoc.
Also, though, a lot of the foods that are "safe" foods for me contain prohibited ingredients. If I removed those from my diet, there really wouldn't be a whole lot left, which would make it even easier for me to go back to full on restricting, since there wouldn't be much pleasure in eating. While part of me longs for that sort of excuse, another part of me says it really isn't worth it.
And right now, I'm experiencing a period of increased depression and hopelessness, which colors my expectations of antidepressants. I look back at my experiences so far, and none of them look like they'd make those additional restrictions worthwhile. You know? I do feel guilty for saying that I would give up the potential benefits in order to feel better, but I also have the long term picture in mind, too: I could give up those things temporarily, but that's not what we'd be talking about. Whatever I find that works for me, has to be taken indefinitely. It really has to be something that offers me adequate quality of life, for as long as I take it. Maybe it's selfish or self-defeating for me to feel this way, but that's not something I could get if I had to deal with the restrictions.
I'm glad it's working for you, though.
Posted by Phillipa on May 15, 2006, at 12:49:27
In reply to Re: what else could my doc prescribe after these?, posted by Racer on May 14, 2006, at 19:39:59
Racer are they really forever? I thought when the depression was gone after a while you could stop with a taper? Love Phillipa
Posted by greywolf on May 15, 2006, at 17:09:38
In reply to what else could my doc prescribe after these?, posted by nickguy on May 14, 2006, at 16:16:13
>Here are the meds my psychiatrist has already prescribed me and didn't work out.
>
> paxil- effexor -cymbalta- lithium- lamictal- gabitril- lexapro -provigil -klonopin -wellbutrin -
>
>
> I know that psychiatrists are by no means relaxed about prescribing maoi's. I know they like to try all the other ones first. So my question is, what else would he prescribe me before letting me try an maoi.
>I'm surprised that your p-doc would go to an MAOI this early. I eventually went on Nardil, but only after exhausting just about every alternative then available (Paxil, Prozac, Luvox, Wellbutrin, Serzone, Zoloft, Lexapro, Effexor, Trazadone, Inderal, Anafranil, Clomipramine, Remeron, and some others I forget). I would discuss the TCAs with him before going to an MAOI.
Posted by JaclinHyde on May 15, 2006, at 19:56:56
In reply to Re: what else could my doc prescribe after these?, posted by greywolf on May 15, 2006, at 17:09:38
Many doctors feel that the TCA's are 'dirtier' drugs than the MAOI's with more side effects and systemic problems (especially cardiac.) If you take out the 'food factor' from the MAOI equation they tend to be a bit safer than the TCA's in most instances.
JH
>I would discuss the TCAs with him before going to an MAOI.
>
Posted by Caedmon on May 15, 2006, at 22:32:08
In reply to Re: what else could my doc prescribe after these?, posted by JaclinHyde on May 15, 2006, at 19:56:56
> Many doctors feel that the TCA's are 'dirtier' drugs than the MAOI's with more side effects and systemic problems (especially cardiac.) If you take out the 'food factor' from the MAOI equation they tend to be a bit safer than the TCA's in most instances.
>
> JH
>
> >I would discuss the TCAs with him before going to an MAOI.
> >
>
Yes I understand that the TCAs are "dirtier". (But, this is kind of a needlessly bad label, IMHO. The action that isn't on monoamines is still sometimes helpful.) I believe the Univ of Texas depression algorithm (?) has you try four antidepressants, one of them either a TCA or high-dose venlafaxine, before an MAOI. At least in some patients.
http://www.mhc.com/Algorithms/Depression/frames.htm- Chris
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