![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 12 to 36 of 52. Go back in thread:
Posted by sissy35 on January 12, 2009, at 17:00:41
In reply to Re: MAOI TX in Severe+Resistant Depression » CaptainAmerica1967, posted by JadeKelly on January 12, 2009, at 16:34:33
Who is going to take away my goose bumps. burrrrr
sissy35
Posted by JadeKelly on January 12, 2009, at 17:41:38
In reply to Re: MAOI TX in Severe+Resistant Depression » JadeKelly, posted by sissy35 on January 12, 2009, at 17:00:41
> Who is going to take away my goose bumps. burrrrr
>
> sissy35Sissy, I don't think you're depressed enough to resort to cold showers are you? And it's not just one!! As to who is going to take away your goose bumps....I'll get working on that (Me first tho)
~Jade tlj*
Posted by CaptainAmerica1967 on January 12, 2009, at 18:52:15
In reply to Re: MAOI TX in Severe+Resistant Depression » CaptainAmerica1967, posted by JadeKelly on January 12, 2009, at 16:34:33
I would expect that 15mgs of Ritalin would be safe as it's not much different than 10mgs.
Here's another aritcle from PsychTropical Research that says there's never been a death using MAOIs and Ritalin together as Ritalin really doesn't have any serotonin effects just noradrenaline.
http://www.psychotropical.com/CNS_stimulants_with_MAOIs.shtmlMethylphenidate and MAOIs have been in use together for 40 years, so it would be surprising if someone had not ingested the combination by now: death, or morbidity, from such an event has not been reported (whereas it has with amphetamine). Methylphenidate is most widely used as a treatment for attention-deficit hyperactivity disorder (ADH) in children. It has been supposed to have serotonergic effects; if that is so it would be predicted to be at high risk of precipitating serotonin toxicity if combined with MAOIs. There are no definite case reports indicating serotonin toxicity with methylphenidate in combination with MAOIs, or other serotonergic drugs (see above) [17-20].
Also, as with mirtazapine and amitriptyline, methylphenidate does not produce serotonergic side effects, or signs of serotonergic toxicity in over-dose or if combined with MAOIs (see Markowitz). Eg the Sherman case was not serotonin toxicity, but blood pressure elevation [21-28].
These observations of serotonergic side effects, and signs of serotonergic toxicity in over-dose, or if combined with MAOIs, have been proposed as a measure of a drugs clinically significant serotonergic effect in humans. If these effects are not produced clinically significant serotonergic effects are unlikely. [29-32].
Methylphenidate also appears safe in combination with MAOIs; see Feinbergs recent and helpful review of MAOIs and CNS stimulants.[1-33-35].
This is in keeping with its negligible 5-HT transporter affinity (>10,000 nmol) and apparent inability to raise brain serotonin levels. Unfortunately Rothmans data does not include methylphenidate so there is no releaser potency data. If methylphenidate acts as a releaser in humans then it would be predicted that its effect would be lessened by selective serotonin reuptake inhibitors (SSRIs)s [21-23-36].
Amphetamine
Amphetamine and MAOIs have also been in use together for 40 years and there are few deaths from apparent serotonin toxicity reported with amphetamine. Amphetamine has weak serotonergic effects; and there seems little risk of precipitating serotonin toxicity if combined with MAOIs. All the case reports with MAOIs and Amphetamine were prior to 1969. The only fatalities have been with MAOIs [37-44].
Amphetamine itself does not seem to produce typical serotonergic side effects, or signs of serotonergic toxicity in over-dose, except hyperreflexia, hyperkinesia (agitation) and hyperpyrexia. Deaths from hyperpyrexia and other causes, but without classic features of serotonin toxicity, have been described. [45-46].
Amphetamine may not be safe in combination with MAOIs (see Feinbergs and Markowitzs recent and helpful reviews of MAOIs and CNS stimulants). It seems to produce noradrenergic toxicity; presumably in the same way as tyramine does, by acting as a releaser. None of these cases were reported to exhibit features that would suggest serotonin toxicity. Several of these cases were fatalities (2 of these below are not cited in the Markowitz paper) [38-41-44].
However, chlorpromazine appears to ameliorate the toxicity symptoms with amphetamine / MAOI as it does with serotonin toxicity.[47].
Amphetamine is 50-100 times less potent for serotonin, both as a releaser and reuptake inhibitor, than for dopamine or noradrenaline (see table). Its 5-HT transporter affinity (~3800 nmol) is extremely weak. However, unlike methylphenidate there is animal work indicating amphetamine does increase serotonin levels [9-22].
In summary, amphetamine definitely has been involved in deaths with MAOIs, and exhibits significant toxicity with venlafaxine (probably serotonin toxicity, as opposed to noradrenergic toxicity). To what degree the toxicity with MAOIs is serotonergic remains uncertain, but most fatalities have been from intra-cerebral bleeding, not serotonin toxicity [2].
If CNS stimulants are to be used to augment monoamine oxidase inhibitors methylphenidate is probably safe; amphetamine is more risky, and can produce moderate noradrenergic toxicity, even at therapeutic doses and perhaps serotonergic side effects, and even serotonin toxicity in over-dose.
MDMA (Ecstasy) 3,4-methylenedioxymethamphetamine
Ecstasy is the street name for 3,4-methylenedioxymethamphetamine (MDMA). Large doses of MDMA cause a rapid release of endogenous serotonin from the stores in the presynaptic nerves; so much so that a substantial MDMA dose will deplete about eighty percent of the serotonin stores. The "half life" of endogenous serotonin is short and the usual duration of symptoms does not frequently allow the development of hyperthermia, although this is influenced by ambient temperature and physical activity.[48-49]
MDMA will occasionally produce, among other things, a picture which is essentially that of serotonin toxicity; however serotonin toxicity sufficiently severe to cause death with MDMA alone is rare.
However such reports as do exist conform with predictions from the spectrum concept of serotonin toxicity and the data in Rothman (see table). No cases of serotonin toxicity with MAOIs had been reported in the literature till 2003. There have been one or two cases where people taking moclobemide, presumably to enhance effects, have been too successful and have experienced severe reactions. I know of one death (unpublished) seemingly from cerebral infarction secondary to arterial spasm. The Vuori report is of four deaths, probably from serotonin toxicity [50].
Posted by CaptainAmerica1967 on January 12, 2009, at 19:10:33
In reply to Re: MAOI TX in Severe+Resistant Depression » sissy35, posted by JadeKelly on January 12, 2009, at 17:41:38
Cold showers work for me, but it doesn't mean it'll help everyone and it may be tough to force yourself to take cold showers. It's kind of like those that are really depressed find it hard to force themselves to work out or exercise to get the benefits from it both short term and long term (increases nerve growth).
Here's one article on the cold shower for depression from Discovery.
http://dsc.discovery.com/news/2007/12/18/depression-cold-shower.html
Posted by sissy35 on January 12, 2009, at 19:24:04
In reply to MAOI TX in Severe+Resistant Depression, posted by CaptainAmerica1967 on January 12, 2009, at 19:10:33
Didn't they use the cold water baths in the so called asyulums years and years ago? Or am I off on this?
Sissy
Posted by CaptainAmerica1967 on January 12, 2009, at 19:54:56
In reply to Re: MAOI TX in Severe+Resistant Depression » CaptainAmerica1967, posted by sissy35 on January 12, 2009, at 19:24:04
Well, in instituitional patients when psychiatry was becoming a science prior to drilling holes in one's head to release the demons, they didn't use cold showers, but experimented some extracts of some plant based medicines (like rauwolfia serpentina or reserpine..used for blood pressure, reduces agitation, but causes depression) and eventually newer medicines (note Freud used cocaine both personally for himself and his patients..it works but long term effects weren't good..it was even in the original Coca Cola).
The earlier smarter practitioners used cold water therapy (rivers, lakes), exercise, certain herbs as well as having their patients bath in lithium rich streams.
Posted by Phillipa on January 12, 2009, at 20:09:00
In reply to MAOI TX in Severe+Resistant Depression, posted by CaptainAmerica1967 on January 12, 2009, at 14:44:22
Definitely a patch as pschologically for me can see it and hence if bad reaction remove even if intellectually know the med is still active in body but it's the knowing it's gone so to speak is a way to help my med phobia. Also both Shawn and JR Becker post here occasionally. Love Phillipa
Posted by sissy35 on January 12, 2009, at 20:31:08
In reply to MAOI TX in Severe+Resistant Depression, posted by CaptainAmerica1967 on January 12, 2009, at 19:54:56
I live in NY near Clifton Springs. Many famous people used to come here for the sulfer baths including Elvis and Betty Davis She left a baby girl here that was less than perfect. It was at that time supposed to heal all types of ills. The psycharitic unit was just next door. Still is. So there have been a lot of attempts to help. You can keep the lobadamy. I would go for deep brain stimulation first.
Better than goose bumps lol
Sissy35
Posted by JadeKelly on January 12, 2009, at 20:42:52
In reply to MAOI TX in Severe+Resistant Depression, posted by CaptainAmerica1967 on January 12, 2009, at 18:52:15
Wow,
Thanks for the response. I'm going to be the resident expert on Amphetamines and MAOI's when you're not around! Well, I feel okay about raising my ritalin then. Not sure what the New York Doc you've talked about uses as stim with MAOI but I'm assuming now its something like Ritalin.
Thanks!
~Jade
Posted by sissy35 on January 12, 2009, at 20:54:22
In reply to Re: MAOI TX in Severe+Resistant Depression » CaptainAmerica1967, posted by JadeKelly on January 12, 2009, at 20:42:52
Jade I used provigil for a long time with nardil.
Tried it with parnate couple of times and no ill effects.Sissy
Posted by JadeKelly on January 12, 2009, at 21:02:09
In reply to e: MAOI TX in Severe+Resistant Depression » JadeKelly, posted by sissy35 on January 12, 2009, at 20:54:22
> Jade I used provigil for a long time with nardil.
> Tried it with parnate couple of times and no ill effects.
>
> SissyHi Sissy, yep, I think they do use that alot too, I tried it once, the only kind of stim that agrees with me is Ritalin.
Jade tlj*
Posted by CaptainAmerica1967 on January 13, 2009, at 0:23:06
In reply to Re: MAOI TX in Severe+Resistant Depression » CaptainAmerica1967, posted by sissy35 on January 12, 2009, at 20:31:08
I live in Houston and tried getting into a DBS study in Dallas and qualified as far as refractory ( over 70 ECT's when I was 19, have tried over 50 psychotherapeutic drugs), but because I had some seizures while on trazodone, I was excluded.
Psychopharmacology is still the best treatment in my opinion.
Posted by Cseagraves on January 13, 2009, at 16:39:32
In reply to MAOI TX in Severe+Resistant Depression, posted by CaptainAmerica1967 on January 12, 2009, at 15:39:50
Hi Captain!!
Am thinking about trying parnate. Have put several posts on here asking about others experiences with parnate. Read both of the articles you posted also.
When I asked my pdoc about parnate he said the rule is that you have to be off all ssri's two weeks prior to beginning. When I asked him about trazodone, he told me I had to be off that also.
I was going to take remeron to help me get through anxieties the next two weeks. Is remeron O.K.?
My biggest concern is my BP. It's controlled with BP med, and while my systolic usually runs between 120-130, my diastolic usually runs between 80-90. Maybe I need a stronger BP med after starting on parnate?? Or should I just monitor it closer while beginning parnate. In your opinion, what is the best thing to do if I see my BP starting to go up or down? I have already informed my GP about parnate and had a full heart work-up about a month ago. Everything came back fine.
Do you find that people with generally high BP have as many problems with hypo-tension? Can I still run and weight train while taking parnate?
I realize that this is something that I will have to monitor closely, but am willing to try the parnate since all other ssri's have failed. (I seem to be very sensitive to them.)Have you or anyone else here on parnate ever gotten to the point of being stable on a regular basis? I know that the first couple of months can be unstable, but as far as being in remission, I would just like to know that with this med I might have a chance at feeling good for a long period of time.
Any advice would be greatly appreciated.
Thanks!!!
Courtney
Posted by CaptainAmerica1967 on January 13, 2009, at 20:32:11
In reply to Re: MAOI TX in Severe+Resistant Depression, posted by Cseagraves on January 13, 2009, at 16:39:32
Hi Courtney,
Yes, the general rule is that you need to be off any SSRI, SNRI for two weeks although the times I went onto-off MAOIs (Tofranil to Nardil...Effexor to Nardil..Nardil to Cymbalta...Cymbalta to Parnate), I never did a washout and started the next day without any problems. Tricyclics are safe with MAOIs too.
According to the psychiatist who is the "guru" on MAOIs I posted earlier, he transitions his patients to MAOI's (if they're on an ssri or snri) by putting them on either trazodone or remeron and building them up and has never had any problems.
I'd just moniter my BP when starting the Parnate if I had BP problems. It may go up or down temporarily, but will probably stabilize after a while. I cannot speak for others, but the MAOI's have generally braught my BP down, and I haven't had any ill effect on my exercising for both my cardiovascular and weight lifting training. When I used Nardil it did cause more hypotension that Parnate and after a heavy squat lift I may have become a little dizzy, but Parnate causes less of this.
I cannot answer for others about how they've responded as far as being stable and in remission. I can tell you my own experience though. I'm 41y/o and my depression started at the age of 15y/o. Out of the twenty-six years I've had treatment resistant depression and out of all the treatments I received (70 ECT, 50 some odd meds, other odd treatment attempts), I have been the most stable on MAOIs although I've had my trying times, but at least I was functionable. I guess I could say remission in a sense that my life was functionable, but the depression has never fully went into remission except two different summers when I exercised three times a day and felt so great that I thought the depression was gone for good until I stopped exercising three times a day and the depression returned.
Hope this helps,
Jeff
Posted by Cseagraves on January 14, 2009, at 14:44:16
In reply to MAOI TX in Severe+Resistant Depression, posted by CaptainAmerica1967 on January 13, 2009, at 20:32:11
Jeff,
Hi and thanks for yout reply.
Couple of questions if you don't mind. Before I start(hope you have some time) my initial dx was extreme GAD and panic, which has now led to agorophobia. I say that I am not depressed, but actually I'm sure that I am because I can't get out and do what I used to do (Was a very active and fun person). On top of that, I get more depressed I'm sure every time I take a med, praying that it will help, only to end up back to where I was.I do try and keep a positive attitude, but it is getting harder.
Was reading over all of the dietary restrictions. They seem to differ depending on which web-site I look at. Since I am a vegetarian, I will have to do some adjusting, but not alot. Your opinion on some of these would help.
No problems with alcohol restrictions, except maybe some vodka or tequila sometimes.
No problem with cheeses that are listed, except maybe parmesean. (Does that mean I can't have Ceasar salads anymore? (Anchovies are in some ceasar dressing)
In resturants, what do you tend to order that's safe?
Proteins - what are protein extracts? What are they in? I drink a good bit of whey protein, sometimes mixing it with some peanut butter and a banana. Is that out, or will I just have to try it and see what happens? I did notice with some whey protein products that some contain amino acids (including tyrosine). I will watch for those.
One of my supplements is a product called "Total Amino Solutions" and it contains 132 mgs of L-tyrosine and 150 mgs. of L-tryptophan. I found this blend of aminos because the level of aminos in this product are supposed to help with depression, anxiety, panic, insomnia and fibromyalgia. I'm sure that I will have to give up this brand. I've looked and can't seem to find any aminos that don't have tyrosine in them. (oh well).
I do eat alot of dark green veggies - especially spinach, turnips, collards, broccoli, celery. I keep seeing spinach come up (New Zealand Prickly). Looked it up and that doesn't look like the spinach I buy in stores. Do I have to give up spinach?
Avocados - not ripe, in small quantities. I mash them up in alot of my raw soups.
Yogurt - small quantities? some sites say O.K., some say no.
Bananas - some sites say o.k (just not the peels), honestly, never heard of anyone eating a banana peel. Some sites say no.
Nuts - I eat alot of almonds and drink almond milk. Love peanuts and peanut butter. Again, some sites say O.K. and some say no.
soy products - I don't eat tofu, but I do eat things like "Morning Star" veggie and chicken patties that contain ingredients like soy protein isolates, soy bean oil, autolyzed yeast extract.
Do you think that would be enough to trigger a reaction. I think (because they are listed so far down on the ingredient list) that maybe they are small in amounts. I can give up soy milk, if I have to.Soy Sauce - I use "Bragg's Liquid Aminos" to flavor some of my raw soups. Maybe thats not to much. I'm sure chinese food is now out of the question. Suck! Sushi O.K.???
Beans - eat alot of beans, have no idea what a fava bean looks like anyway. Not sure what other broad beens they are referring to. One site said no "lentils"?
CHOCOLATE - Really??? Seriously, no more M& M's or chocolate chips. My one and only treat that I allow myself is chocolate and peanut butter morsel chips.(about a handful of these each almost every night). That really blows!!!
I understand that everyones body can react differently. I'm sure alot of this is trial and error. I am beginning to feel like the parnate is my last shot. SSRI's didn't work anymore and I'm not sure if I want to even experiment with an SNRI.
I am hoping that more peeps add their post to let me know what they experienced first going on parnate. How long were you on it before you started feeling good side-effects from it? Can I expect to feel kind of out of it or sluggish for awhile. I'm 5'2 and weigh 125 lbs (I'm also 41), so was wondering when I could hopefully start to feel better.
I've read some post who say they could feel a difference within the first couple of days and others who say they took awhile. I feel like if I could just get to the point where I could get back out in public and not feel anxietal at the thought of going to the grocery store or picking my son up from school, then I could get past the depression. Re-train my brain. Go back to and finish school and get a job would be great. Just want to feel like a producttive part of society instead staying in my house all the time.
Jade had posted where in the beginning she had 10 straight days of feeling great, then came back down? Why was that? Am assuming that it was just her body metabolizing the med. I know you can't tell me exactly what to expect, but I just want to feel level so bad. I have a whole gym set up in my basement that I haven't touched in 6 months (I have anxiety attacks everytime I think of working out and have no idea why).
Sorry for the long babble. At first the parnate scared me, but the more I get to know about it. it doesn't seem that bad. Don't understand why it is made out to be such scary stuff. The diet restrictions aren't that difficult and just keeping an eye on my BP will not be a problem.
I asked my pdoc if he had ever had a patient experience a hypertensive crisis and he said "no".
If parnate can actually lower my blood pressure a little, then that would be an advantage to me. From what I understand, BP levels out after being on parnate for a little while, so lets hope thats the case with me.
I truly appreciate your time. As you can probably tell, I'm a little OCD about everything I put in my mouth. (diet and meds).
Thank you again and have a great day!!
Courtney
Posted by CaptainAmerica1967 on January 14, 2009, at 17:26:27
In reply to Re: MAOI TX in Severe+Resistant Depression, posted by Cseagraves on January 14, 2009, at 14:44:16
There's an awesome book called "The Anxiety Disease" by David Sheehan, M.D. (one of the most thought of psychiatrist in treating anxiety) that came out around 1990. You should buy it on Amazon. It's a great book on both the biological control of GAD, panic diorder, phobias, and anticipatory anxiety as well as some of the learned behaviors (ie agoraphobia) you get from the biological based anxiety and fear one "accidentally" learns or associates situations with during their anxiety . I've always had severe anxiety with my depression and at one time developed a little agoraphobia while on some of the tricyclic as the imipramine made my heart race.
I'm a vegetarian as well and have never had any problems with any of my whey protein supplement (whey is great for the immune system as well) drinks or other supplements as long as they don't contain any ephedrine type products which I never dared trying. Don't be concerned about tyrosine. It's the amino acid that gets converted into norepinephrine, but at mega doses it may affect your blood pressure.
Reread the article I posted on MD says Dexedrine, Trazodone, Remeron are ok with MAOIS as it tells it straight forward on what one really needs to not eat while on MAOIs (the new research on actually measuring tyramine content of foods and drinks) which isn't much except age cheeses (I always thought pizza was out and haven't eaten pizza because of the cheese but am going to try some), tap beer (I cannot stand the taste of beer anyways), fava beens (contain L-Dopa which converts into dopamine), sauerkraut, tofu, soy sauce and miso soup. Fresh cheeses and diary products including yogurt is fine as well as wine (even red wine which I thought was a no no, but maybe no chianti wine), most bottled beers (not sure about canned beer as the lack of sunlight allows fermentation and hence tyramine increase), most hard liquors (I like Bailey's but have never tried while on an MAOI as it has milk type products that have sat over time, I've had no problems with others like Sambuca..note Licorce actually has a small MAOI effect and helps mood as well as muscle fatigue as it stimulates cortisteroids), chocolate (never ever had a problem but I've never eaten it in hugh quanities unless you're taking about my protein shakes...I'm 5'11' and pretty much all muscle at 240pds and need the protein being a vegeatrian), coffee (I don't drink it..don't like the taste and you should either as it can preciptate panic attacks from the caffeine). When dining out just ask them about the specifics as for as things being aged or soy sauce being added. I probably eat 5 bananas a day and never had a problem but I like them almost on the green side and not real ripe. Oranges contain a natural neosynephrine which is why they help clear up sinuses during a cold, but I eat several oranges a day as well. I don't eat peanut butter because of the fat content, but do eat peanuts and nuts. I eat lentil soup ever week with no problems, but maybe some lentil soups have a soy sauce put into it?
I noticed the effect of the MAOI's the very same day I started taking them and was amazed that so many physicians are scared to use them when they are so effect.
I have confidence it will work for you.
Best of luck,
Jeff
Posted by Cseagraves on January 14, 2009, at 21:29:12
In reply to MAOI TX in Severe+Resistant Depression, posted by CaptainAmerica1967 on January 14, 2009, at 17:26:27
Jeff,
Thanks so much for your response. Sorry to bombard you with so many questions, but it seems you and I have alot in common, especially our diets. I'm 5'2 and weight stays around 120-125 lbs.
Use to work out all the time. Miss it so much. I keep telling myself if I can just get down there and force myself, I could get motivated to start back. Don't understand why I get anxietal at the thought of it when I was so religious about it before.
I did try to start back running this week, But weening myself off of the lexapro and then having the awful side effects to the trazodone over the last couple of days have floored me. Was going through all of my books trying to find a good detox to see if I could get this out of my system quicker. I just ordered some more MAX GXL (off e-bay, alot cheaper)as it has alot of good healing nutrients and always made me feel better. Alot of body-builders use and it is a good detox for body, but I was trying to find a good quick cleanse also.
The last book on anxiety I read was "Coping with Anxiety" by Dr. Edmund Bourne, but it didn't really tell me anything I hadn't already researched before as far as how to cope with anxiety. I'll definately look up "The Anxiety Disease". Would love to figure how this started.
I've never drank any of those ephedrine drinks that were at the gym or in the stores. Scarey to me. Red Bulls and other energy drinks scare me also, plus I don't like anything carbonated (soft drinks)and I don't like anything that taste fruity. So basically the only thing I drink is decaffeinated green tea and maybe occasionally some decaf coffee in the morning, my whey shakes,(sometimes I'll switch up and throw some blueberries and strawberries into the mix instead of bananas and peanut butter.
Maybe I'm confused about something I thought I had read. I thought we had to watch out for tyrosine in products because taking maoi's screwed with the conversion of tyrosine to tyramine in our bodies. Do you take amino supplements that contain tyrosine? Because I was really upset that I would have to give up my aminos. I'M SO CONFUSED!!!
Like you, beer to me has always been disgusting. I like a glass of red wine every once in a while.(usually a sangria) One site said no liquers (so I was wondering if Kahlua was O.K., but since its a coffee based drink, then probably not a good idea. Will keep the Sambuca in mind. Never drank much anyway. Don't like feeling drunk ( I have enough issues)LOL!!!, but I like a couple of shots of a good tequila every now and then when I'm out with friends. It's quick, fast and effective and doesn't give me a headache. (Not that I go out now anyway, GOD I MISS MY BEFORE LIFE!!!!)
I know I asked you a bunch of questions before, but you didn't give me feedback regarding veggie burgers or vegetarian "chicken" patties. I am assuming since they are soy based, then they are probably a no-no. Maybe I could just try one and see what happens, ya think?
I see that we are very pro-active as far as health goes, but was wondering what you do when you do get a cold or flu. What can we take?
Thanks again for your time and info.
Hope will talk soon.
CS
Posted by CaptainAmerica1967 on January 15, 2009, at 0:43:08
In reply to Re: MAOI TX in Severe+Resistant Depression, posted by Cseagraves on January 14, 2009, at 21:29:12
Sorry,
I thought I answered the tyrosine question because it's present in high enough doses in whey protein shakes so why should it be different in capsule form although amino acids do compete to cross the blood brain barrier, but it should make a difference. Again, I re-wrote most of the article (MD says Dexdrine, bla, bla, bla) to show you that the only things you have to worry about is what I re-wrote.
I didn't answer the veggie burgers because it' safe both according to what I spent time re-writing the article and I personally eat veggie burgers and never had a problem.
Good luck,
Jeff
Posted by Cseagraves on January 15, 2009, at 14:21:06
In reply to MAOI TX in Severe+Resistant Depression, posted by CaptainAmerica1967 on January 15, 2009, at 0:43:08
Sorry.
Thanks for all the info - will look it up.
CS
Posted by CaptainAmerica1967 on January 15, 2009, at 20:29:58
In reply to Re: MAOI TX in Severe+Resistant Depression, posted by Cseagraves on January 15, 2009, at 14:21:06
Also, there are some other meds your physician my not be aware of that when used off label for anxiety, social phobia, agoraphobia, panic disorder, GAD, PTSD, can be very effective.
GHB (XyRem) or gamma-hyroxy-butyrate is a medicine indicated for narcolepsy and excessive daytime sleepiness. However, in smaller doses taken prior to going out to socialize or any thing or place that causes anxiety, it can do wonders. I've personally used it especially a very small amount prior to giving a speak to a large group and it makes you want to talk and more open and "inhibits" your fear kind of like alcohol does, but better. However, it can cause rebound anxiety and whenever I took it, I'd always take a very low dose of xanax to prevent the potential rebound anxiety. Testing is being done by Jazz Pharmaceuticals for multiple uses such as a socializing drug as well as other indications.
Oxytocin is the hormone of cuddle and helps us to fall in love as well as promote uterine contractions during child birth, but has some potential as an antidepressant, anxiolytic, and a socializing hormone. It's one of two hormones secreted by the posterior pituitary and is available by injection (used mainly by OBGYN's to induce labor) and as a spray (easier to take and crosses the blood brain barrier better).
D-Cycloserine is an antibiotic with interesting potential uses and some studies show individual taking it prior to a phobic event learn not to fear it.
Beta-blocking drugs like Inderal (propranolol) prevent the run away adrenaline fear one feels in a scary situation and some people take it prior to speaking (stage fright) or flying (acrophobia). However, Inderal can cause depression, but there's a more specific beta-blocker used to help depression called Viskin or pindolol which might help you.
Posted by desolationrower on January 16, 2009, at 1:59:07
In reply to Re: e: MAOI TX in Severe+Resistant Depression, posted by JadeKelly on January 12, 2009, at 21:02:09
> > Jade I used provigil for a long time with nardil.
> > Tried it with parnate couple of times and no ill effects.
> >
> > Sissy
>
> Hi Sissy, yep, I think they do use that alot too, I tried it once, the only kind of stim that agrees with me is Ritalin.
>
> Jade tlj*i wouldn't assume that since ritalin is the only stim that you like on its own, that its necessarily the best one while you're on an MAOI.
-d/r
Posted by desolationrower on January 16, 2009, at 2:28:22
In reply to Re: MAOI TX in Severe+Resistant Depression, posted by Cseagraves on January 14, 2009, at 14:44:16
> Jeff,
>
> Hi and thanks for yout reply.
>
> Couple of questions if you don't mind. Before I start(hope you have some time) my initial dx was extreme GAD and panic, which has now led to agorophobia. I say that I am not depressed, but actually I'm sure that I am because I can't get out and do what I used to do (Was a very active and fun person). On top of that, I get more depressed I'm sure every time I take a med, praying that it will help, only to end up back to where I was.I do try and keep a positive attitude, but it is getting harder.
>
> Was reading over all of the dietary restrictions. They seem to differ depending on which web-site I look at. Since I am a vegetarian, I will have to do some adjusting, but not alot. Your opinion on some of these would help.
>
> No problems with alcohol restrictions, except maybe some vodka or tequila sometimes.Its really just tap beers. Chianti probably too, although only a single vintage ever tested high for tyrosine afaik.
> No problem with cheeses that are listed, except maybe parmesean. (Does that mean I can't have Ceasar salads anymore? (Anchovies are in some ceasar dressing)
i would be carful with anchovies. i quit eating shrimp paste/oyster sauce.
> In resturants, what do you tend to order that's safe?
fortunatly for me, unemployment moots this problem.
> Proteins - what are protein extracts? What are they in? I drink a good bit of whey protein, sometimes mixing it with some peanut butter and a banana. Is that out, or will I just have to try it and see what happens? I did notice with some whey protein products that some contain amino acids (including tyrosine). I will watch for those.
protein powder is fine, i think the bigger risk is the sort of 'meat flavour' artificial flavor in broths.
> One of my supplements is a product called "Total Amino Solutions" and it contains 132 mgs of L-tyrosine and 150 mgs. of L-tryptophan. I found this blend of aminos because the level of aminos in this product are supposed to help with depression, anxiety, panic, insomnia and fibromyalgia. I'm sure that I will have to give up this brand. I've looked and can't seem to find any aminos that don't have tyrosine in them. (oh well).
tryptophan/5htp is a bit of a risk
> I do eat alot of dark green veggies - especially spinach, turnips, collards, broccoli, celery. I keep seeing spinach come up (New Zealand Prickly). Looked it up and that doesn't look like the spinach I buy in stores. Do I have to give up spinach?
>
> Avocados - not ripe, in small quantities. I mash them up in alot of my raw soups.
>
> Yogurt - small quantities? some sites say O.K., some say no.i'm not sure on this. i think its safe, analogus to the quick ferment cheeses which are safe.
> Bananas - some sites say o.k (just not the peels), honestly, never heard of anyone eating a banana peel. Some sites say no.
>
> Nuts - I eat alot of almonds and drink almond milk. Love peanuts and peanut butter. Again, some sites say O.K. and some say no.nuts are fine.
> soy products - I don't eat tofu, but I do eat things like "Morning Star" veggie and chicken patties that contain ingredients like soy protein isolates, soy bean oil, autolyzed yeast extract.
> Do you think that would be enough to trigger a reaction. I think (because they are listed so far down on the ingredient list) that maybe they are small in amounts. I can give up soy milk, if I have to.the autolyzed yeast extract would be the main thing i would be concerned with.
> Soy Sauce - I use "Bragg's Liquid Aminos" to flavor some of my raw soups. Maybe thats not to much. I'm sure chinese food is now out of the question. Suck! Sushi O.K.???
Sushi is ok if you don't use soy sauce. and, a little bit of soy sauce could be ok, definatly stick to a brand and be aware of what else you're eating. it just is a matter of how much you want to risk it.
> Beans - eat alot of beans, have no idea what a fava bean looks like anyway. Not sure what other broad beens they are referring to. One site said no "lentils"?
lentils are fine.
> CHOCOLATE - Really??? Seriously, no more M& M's or chocolate chips. My one and only treat that I allow myself is chocolate and peanut butter morsel chips.(about a handful of these each almost every night). That really blows!!!
chocolate is fine.
> I understand that everyones body can react differently. I'm sure alot of this is trial and error. I am beginning to feel like the parnate is my last shot. SSRI's didn't work anymore and I'm not sure if I want to even experiment with an SNRI.
>
> I am hoping that more peeps add their post to let me know what they experienced first going on parnate. How long were you on it before you started feeling good side-effects from it? Can I expect to feel kind of out of it or sluggish for awhile. I'm 5'2 and weigh 125 lbs (I'm also 41), so was wondering when I could hopefully start to feel better.
>
> I've read some post who say they could feel a difference within the first couple of days and others who say they took awhile. I feel like if I could just get to the point where I could get back out in public and not feel anxietal at the thought of going to the grocery store or picking my son up from school, then I could get past the depression. Re-train my brain. Go back to and finish school and get a job would be great. Just want to feel like a producttive part of society instead staying in my house all the time.
>
> Jade had posted where in the beginning she had 10 straight days of feeling great, then came back down? Why was that? Am assuming that it was just her body metabolizing the med. I know you can't tell me exactly what to expect, but I just want to feel level so bad. I have a whole gym set up in my basement that I haven't touched in 6 months (I have anxiety attacks everytime I think of working out and have no idea why).
>
> Sorry for the long babble. At first the parnate scared me, but the more I get to know about it. it doesn't seem that bad. Don't understand why it is made out to be such scary stuff. The diet restrictions aren't that difficult and just keeping an eye on my BP will not be a problem.
>
> I asked my pdoc if he had ever had a patient experience a hypertensive crisis and he said "no".
>
> If parnate can actually lower my blood pressure a little, then that would be an advantage to me. From what I understand, BP levels out after being on parnate for a little while, so lets hope thats the case with me.
>
> I truly appreciate your time. As you can probably tell, I'm a little OCD about everything I put in my mouth. (diet and meds).
>
> Thank you again and have a great day!!
>
> Courtney
>
>
>
>
>heres a summary of more modern recommendations. A lot of sites just read some other web sites, and make a list, then add a couple of foods just in case. http://www.edc.gsph.pitt.edu/stard/public/docs/PatientEducationMaterials/User%20Friendly%20MAOI-diet.pdf
-d/r
Posted by Cseagraves on January 16, 2009, at 11:57:34
In reply to Re: MAOI TX in Severe+Resistant Depression, posted by desolationrower on January 16, 2009, at 2:28:22
D/S'
Thank you so much for your response. Makes me feel better that the diet isn't all that difficult. Still not sure about resturants, but will figure that one out.
Honest, have you ever heard of any one eating a banana peel? LOL!!!
Courtney
Posted by Cseagraves on January 16, 2009, at 12:02:45
In reply to GHB, Oxytocin, D-Cycloserine, others off-label, posted by CaptainAmerica1967 on January 15, 2009, at 20:29:58
Jeff,
Thanks for the info. I am assuming you sent this regarding the anxieties that I said I was experiencing just trying to get out of the house. I am printing out alot of this stuff to show and ask my pdoc about when I go back.
Another question please. Do you take a blend of aminos?
Courtney
Posted by Cseagraves on January 16, 2009, at 12:24:49
In reply to GHB, Oxytocin, D-Cycloserine, others off-label, posted by CaptainAmerica1967 on January 15, 2009, at 20:29:58
As far as the GHB goes, would that be o.k. to take for fatigue that I might experience while taking the parnate or would the GHB be better for emergencies only?
Was curious as to what levels of fatigue most peeps experience when taking parnate and does it eventually go away.?
Thanks, CS
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