![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 14 to 38 of 80. Go back in thread:
Posted by Robert_Burton_1621 on July 21, 2015, at 16:36:50
In reply to Stopping Parnate for surgery? Help!, posted by Uncouth on July 20, 2015, at 10:20:26
Uncouth, I would take sceptically the assertion that the combination of parnate with strattera carries a dangerous and significant risk of causing hypertensive crisis and death.
Note that the poster who gave the warning provided no detail of the causal mechanism of the claimed risk.
There is no doubt that CNS stimulatants ought be used cautiously with MAOIs. Amphetamine has been implicated in deaths (subarachnoid hemorrhage) when combined with MAOIs, probably as a result of noradrenergic toxicity. However, chlorpromazine seems to reduce the toxity.
Amphetamine is a *releaser* (indirect agonist) of noradrenaline. Tyramine is also such a releaser, and for this reason can cause a hypertensive crisis if consumed in sufficient potency. This is why people on MAOIs must follow a restricted diet.
But not every medication with a capacity to increase noradrenergic neurotransmission acts as a *releaser". In fact, the NRIs roboxetine, nortriptyline, wellbutrin, can actually prevent a tyramine-induced hypertensive response.
Consult: http://www.psychotropical.com/maois-and-cns-stimulants, and the references there cited.
Ritalin, which acts as an NRI and DRI, has been used in combination with MAOIs for decades but Gillman, a meticulously thorough researcher, could not identify any reports of death.
Strattera is also an NRI, so it would assist in reducing the pressor effect of tyramine. It is reasonable to deduce that the risk it carries of inducing a hypertensive crisis when co-adminstered with parnate is analogous to that of ritalin or wellbutrin, which is very small when their co-administration is monitored properly.
Atomoxetine (strattera) does not appear to be a potent NRI anyway, since even overdoses up to 1500mg have not, apparently,induced death via noradrenergic toxicity.
For more well-reasoned and supported information, see Gillman's excellent site and:
Feinberg SS., "Combining stimulants with monoamine oxidase inhibitors: a review of uses and one possible additional indication," Journal of Clinical Psychiatry (2004) 65: 1520-4.
Posted by Lou Pilder on July 21, 2015, at 16:48:37
In reply to Lou's response-their blood » 10derheart, posted by Lou Pilder on July 21, 2015, at 15:59:56
> > -nhelpful? Self-centered? Obsessed with imaginary problems on PB?
> >
> > apparently. ;-)
>
> Friends,
> Many of you already know that I am here to save lives, prevent life-ruining conditions and addictions. And I am trying so hard, laboring under many prohibitions posted to me here by Mr. Hsiung, to free the captives and lead people back to the green fields that they used to know.
> And here there are many that have been killed by the drugs being allowed to be promoted here as medicines. And worse, members post that they take a combination of drugs that if they don't kill them, they could be addicted or get a life-ruining condition. All of that under the banner of support as Mr. Hsiung's rules are under that being supportive takes precedence. That could mislead readers to think that taking a combination of drugs that could kill them is being supportive here. And look at all those that have died here that you can see. But what about those that have been killed by the drugs that you can't see here? There are thousands killed each month by these drugs. Drugs that many start with motor oil that have chemical constituents that have been used to kill insects and rats and used in the commission of mass-murder even to this day. And the mothers trying to decide. Their child could be killed by taking the combination of chemicals advocated here as being supportive as the rules state and members are in doubt?
> If someone else greater than me posted here you might believe. Where have you gone Dr. Quackenbush, a forum turns its doubtful hearts to you. But as long as this being allowed here as to be seen as supportive and readers are killed by the combination of those drugs, so shall I attempt to warn them, and their blood will not be upon me.Friends,
If someone greater than me told you what I also posted, would you stand up and walk out on me?
Here is a vid that is by one greater than me, Dr. Peter Gotzsche. Maybe you will listen to him.
Lou
to see this video bring up Google and type in:
[ youtube, dozpAshvtsA ]
Posted by 10derheart on July 21, 2015, at 19:21:14
In reply to Re: Being alarmist? Hyperbolic? Extreme? Ridiculous? U » 10derheart, posted by Robert_Burton_1621 on July 21, 2015, at 15:53:49
You have quite the way with words, Robert Burton. Yes, indeed.
I assume this group is supposed to include me...
>>...on the other, we have the fickle mob of enabling "supporters", whose amorality makes it easy for them without conscience to become complicit in psychiatry's conspiracy to make its patients worse rather than better off.
You don't know me, so I'm not sure what's up with the labeling. I will say I am generally not fickle, definitely not amoral or without conscience, or complicit in anything to do with psychiatry or its patients. Haven't been to a pdoc in over 11 years, nor have I studied the current state of the field at all so I could form an overall opinion of its helpfulness. It is Mr. Pilder's tone and tactics I criticize. His message, if it is anti-drug, is welcome in the interest of free speech, to the extent Dr. Bob allows that. (Which is apparently 100% at the moment.)
PB is too anemic and underpopulated to produce any sort of "mob." If only that were possible, it might be worth it to again have more robust and varied dialog. But, the past is the past, I guess.
Posted by Robert_Burton_1621 on July 21, 2015, at 19:41:53
In reply to Re: Being alarmist? Hyperbolic? Extreme? Ridiculous? U » Robert_Burton_1621, posted by 10derheart on July 21, 2015, at 19:21:14
> You have quite the way with words, Robert Burton. Yes, indeed.
>
> I assume this group is supposed to include me...
>
> >>...on the other, we have the fickle mob of enabling "supporters", whose amorality makes it easy for them without conscience to become complicit in psychiatry's conspiracy to make its patients worse rather than better off.
>
> You don't know me, so I'm not sure what's up with the labeling. I will say I am generally not fickle, definitely not amoral or without conscience, or complicit in anything to do with psychiatry or its patients. Haven't been to a pdoc in over 11 years, nor have I studied the current state of the field at all so I could form an overall opinion of its helpfulness. It is Mr. Pilder's tone and tactics I criticize. His message, if it is anti-drug, is welcome in the interest of free speech, to the extent Dr. Bob allows that. (Which is apparently 100% at the moment.)
>
> PB is too anemic and underpopulated to produce any sort of "mob." If only that were possible, it might be worth it to again have more robust and varied dialog. But, the past is the past, I guess.10derheart, I think you have misinterpreted me. The quote you cite was not a serious characterisation of anyone, but an attempt to express how it seems that many of us are assumed to be from the perspective of the gentleman in question. It was intended to satirise this perspective when it expresses itself hyperbolically and at the expense of reasoned dailogue which accepts that posters who refuse to agree with the hyperbole are therefore complicit in "supporting" choices to continue with medication which is asserted to be lethal.
Apologies if that satirical purpose wasn't entirely clear. In the past I have entirely agreed with your totally reasonable views on the gentleman's "tone and tactics", and still do.
Needless to say, nothing in the words you extract was meant to articulate my view of you or anyone else at PB.
Posted by Lou Pilder on July 21, 2015, at 20:13:26
In reply to Lou's response-someone greter than me, posted by Lou Pilder on July 21, 2015, at 16:48:37
> > > -nhelpful? Self-centered? Obsessed with imaginary problems on PB?
> > >
> > > apparently. ;-)
> >
> > Friends,
> > Many of you already know that I am here to save lives, prevent life-ruining conditions and addictions. And I am trying so hard, laboring under many prohibitions posted to me here by Mr. Hsiung, to free the captives and lead people back to the green fields that they used to know.
> > And here there are many that have been killed by the drugs being allowed to be promoted here as medicines. And worse, members post that they take a combination of drugs that if they don't kill them, they could be addicted or get a life-ruining condition. All of that under the banner of support as Mr. Hsiung's rules are under that being supportive takes precedence. That could mislead readers to think that taking a combination of drugs that could kill them is being supportive here. And look at all those that have died here that you can see. But what about those that have been killed by the drugs that you can't see here? There are thousands killed each month by these drugs. Drugs that many start with motor oil that have chemical constituents that have been used to kill insects and rats and used in the commission of mass-murder even to this day. And the mothers trying to decide. Their child could be killed by taking the combination of chemicals advocated here as being supportive as the rules state and members are in doubt?
> > If someone else greater than me posted here you might believe. Where have you gone Dr. Quackenbush, a forum turns its doubtful hearts to you. But as long as this being allowed here as to be seen as supportive and readers are killed by the combination of those drugs, so shall I attempt to warn them, and their blood will not be upon me.
>
> Friends,
> If someone greater than me told you what I also posted, would you stand up and walk out on me?
> Here is a vid that is by one greater than me, Dr. Peter Gotzsche. Maybe you will listen to him.
> Lou
> to see this video bring up Google and type in:
> [ youtube, dozpAshvtsA ]Friends,
Let us enter the conversation with the hypothetical people, Dr. Quackenbush and client Helen Weilz.
Dr. Quackenbush: How do you feel today, Helen?
Helen Weilz: I am feeling pretty sick now.
Dr. Quackenbush: Do you want me to call you an ambulance?
Helen Weilz: I have been called worse than that.
Dr. Quackenbush: Well, did you take a shower this morning?
Helen Weilz: Why, is there one missing?
Dr. Quackenbush: Have you been looking at that "Dr. Bob" site?
Helen Weilz: That Lou guy says that taking Strattera with Parnate could cause death. Is he right?
Dr. Quackenbush: Yes, he is. The two taken together is contraindicated and could raise blood pressure that could cause death. I would never prescribe them both together
Helen Weilz: But this other guy says that taking a stimulant with Parnate like Ritalin, could not cause such and Strattera is a stimulant.
Dr. Quackenbush: But just because they are both stimulants, they could have two different modes of action with Parnate. Like if there were two snakes to handle, one could inject in its bite poison and the other not, even though they are both snakes.
Helen Weilz; Hey that really clears that up. I think that you ought to enter that forum and help them think like that. Another poster writes of great fear about taking drugs. There is a whole lot of shakin' goin' on.
Dr. Quackenbush; I will look into that site and see if I can help those people.
Lou
Posted by 10derheart on July 22, 2015, at 0:58:57
In reply to Re: Being alarmist? Hyperbolic? Extreme? Ridiculous? U » 10derheart, posted by Robert_Burton_1621 on July 21, 2015, at 19:41:53
Ahh...thanks for clarifying. Now I've re-read your post I can see another meaning - the one you intended :-) Maybe I was unconsciously in some sort of defensive mode when I read it before. I won't pretend to understand my own states of mind completely....just better than I used to! ;-)
Oops. Apologies.
Words are so beautiful, yet so tricky and downright devilishly complicated to navigate sometimes. Then add in asynchronous communication and you have a poor recipe for understanding.
Posted by Lou Pilder on July 22, 2015, at 5:45:54
In reply to Re: Being alarmist? Hyperbolic? Extreme? Ridiculous? U » Robert_Burton_1621, posted by 10derheart on July 21, 2015, at 19:21:14
> You have quite the way with words, Robert Burton. Yes, indeed.
>
> I assume this group is supposed to include me...
>
> >>...on the other, we have the fickle mob of enabling "supporters", whose amorality makes it easy for them without conscience to become complicit in psychiatry's conspiracy to make its patients worse rather than better off.
>
> You don't know me, so I'm not sure what's up with the labeling. I will say I am generally not fickle, definitely not amoral or without conscience, or complicit in anything to do with psychiatry or its patients. Haven't been to a pdoc in over 11 years, nor have I studied the current state of the field at all so I could form an overall opinion of its helpfulness. It is Mr. Pilder's tone and tactics I criticize. His message, if it is anti-drug, is welcome in the interest of free speech, to the extent Dr. Bob allows that. (Which is apparently 100% at the moment.)
>
> PB is too anemic and underpopulated to produce any sort of "mob." If only that were possible, it might be worth it to again have more robust and varied dialog. But, the past is the past, I guess.10,
You wrote,[...It is Mr. Pilder's tone and tactics that I criticize...].
What you have posted about me here could induce hostile and disagreeable opinions and feelings toward me and decrease the respect, regard and confidence in which I am held. This is all because your criticisms toward me and what the tone is can not be seen. If you could post answers to the following, then I could respond accordingly.
A. What is the tone that you are criticizing me for?
B. What are the tactics that you are criticizing me for?
C. Do you want me to be prevented from posting here what I think could save lives, prevent life-ruining conditions and addictions and if so, why would you want to prevent me from doing that?
D. Do you think that by Mr. Hsiung and his deputies of record using the tactic of discrimination by denying me equal protection of his rules by not acting on my notifications here, that by him and his deputies of record doing that, this community will be improved as Mr. Hsiung states that he does what in his thinking will be good for this community as a whole?
E. Mr. Hsiung wants you to trust him in that. Are you trusting him in thinking that by him and his deputies of record allowing anti-Semitic propaganda to be seen as supportive here, that this community will be "good" for him and his deputies of record doing that?
F. If you post here what you are criticizing me for, and that decreases the respect, regard and confidence in which I am held so that some readers are killed by the drugs that are being allowed to be promoted here as medicines, would their blood be upon you?
Lou
Posted by Lou Pilder on July 23, 2015, at 9:21:31
In reply to Re: Being alarmist? Hyperbolic? Extreme? Ridiculous? U » 10derheart, posted by Robert_Burton_1621 on July 21, 2015, at 15:53:49
> > -nhelpful? Self-centered? Obsessed with imaginary problems on PB?
> >
> > apparently. ;-)
>
> It is the confident assertion of misinformed opinion and sweeping anti-medication prejudice that is most concerning. Such misinformation is offered portentously as if it were hard-headed but ultimately necessary advice which places a priority on the best interests of the perplexed poster in preference to the facile and irresponsible provision of a form of "support" whose consequences lead directly to death. On one side, we have the lone, courageous and ethically-irreproachable truth-teller whose warnings of death and disaster fall too frequenlty on deaf ears; on the other, we have the fickle mob of enabling "supporters", whose amorality makes it easy for them without conscience to become complicit in psychiatry's conspiracy to make its patients worse rather than better off.
>
> The most pitiful and lamentable casualties of this binary battle are nuance, well-informed research, evidence-based reasoning, a willingness rationally to consider counter-arguments, and an acknowledgement of one's own limitations.
>
> Alarmist? Hyperbolic? Extreme?
>
> Yes. Objectively these are accurate characterisations, however sincere a person believes his or her subjective intention is.Friends,
Be not deceived as to what is allowed to be posted about my character here as being seen as supportive. You could be indoctrinated here by that Mr. Hsiung states that being supportive takes precedence and that if something is not acted on by him or his deputies of record, then what is in question is not against his rules.
bUt be advised that I think that by Mr. Hsiung denying me equal protection of his rules leaving statements against me here to be seen as civil, that by him doing that, death could be a result of participating here as thinking that what can be seen unsanctioned is being supportive. This includes posters advocating to take combinations of drugs that can kill you. The question is if I am alone here in warning readers of the potential of you getting a life-ruining condition or addiction or death from these drugs and why is it allowed for posters to advocate what could cause your death and why a=is anti-Semitic propaganda allowed to be posted here with impunity? And there are prohibitions to me here from Mr. Hsiung that prevent me from educating you that in my perspective could save your life and since I am prohibited by Mr. Hsiung to post what I think could save your life, then who will have the blood of those that are killed here upon them by them that contribute to the promotion of these drugs?
Let us look at the flowing two videos.
Lou
[ youtube, KMoZcmm-9Ew ]
and
[ youtube, rjOxheddSEE ]
Posted by Uncouth on July 23, 2015, at 11:26:19
In reply to Stopping Parnate for surgery? Help!, posted by Uncouth on July 20, 2015, at 10:20:26
Despite the fact that this thread has taken a turn for the off-topic, I wanted to update everyone. My pdoc says stop as well, despite the evidence and helpful references on this thread I emailed him and the surgeon/anesthesologist.
I will be tapering down Parnate by 10mg/day over the next 13 days. I am a bit worried, but will likely escalate my doses of other medications I am allowed to stay on, Strattera 80->100mg, Namenda XR 21->28mg, Abilify 2mg->5mg if necessary, and possibly restarting armodafinil if necessary. Wish me luck.
Posted by Lou Pilder on July 24, 2015, at 8:05:26
In reply to Re: Stopping Parnate for surgery? Help! » Uncouth, posted by Uncouth on July 23, 2015, at 11:26:19
> Despite the fact that this thread has taken a turn for the off-topic, I wanted to update everyone. My pdoc says stop as well, despite the evidence and helpful references on this thread I emailed him and the surgeon/anesthesologist.
>
> I will be tapering down Parnate by 10mg/day over the next 13 days. I am a bit worried, but will likely escalate my doses of other medications I am allowed to stay on, Strattera 80->100mg, Namenda XR 21->28mg, Abilify 2mg->5mg if necessary, and possibly restarting armodafinil if necessary. Wish me luck.
>
> uncouth,
You wrote,[...My pdoc says stop...despite the evidence and helpful references in this thread..].
If you could post answers to the following , then I think that lives could be saved, life-ruining conditions and addictions could be avoided.
True or false:
A. My p-doc, Lou, p-doc says to stop the Parnate
B. There is evidence posted in this thread that contradicts my p-doc, Lou, to have me stop Parnate
C. You are correct, Lou, that the combination of Parnate with Strattera could cause death by high blood pressure
Fill in:
D. The evidence that I am referring to in this thread, Lou, is:
_____________________________________________
___________________________________________
Lou
Posted by Uncouth on July 24, 2015, at 10:49:16
In reply to Lou's urgent request-ehvahdenz » Uncouth, posted by Lou Pilder on July 24, 2015, at 8:05:26
Who the f*ck do you think you are?
Get off this site.If you actually read the references others have pointed to you would realize that a combination of an MAOI and an NRI is not only not dangerous, it is a potent and important combination for treatment resistant depression and, I will repeat what others have said, 'LOU', MAKES MAOIs SAFER AS IT SEVERELY ATTENUATES HYPERTENSIVE CRISES AS A RESULT OF TYRAMINE INGESTION.
Note that ever since I have started the atomoxetine and hit a stable and reasonable dose of 80mg, I have had no problems eating whatever I wantaged cheeses, meats, fermented foods, etc. with ZERO and I mean ZERO BP effects. Before the parnate, I would often feel transient and brief increases in BP from small levels of tyramine in even normal or safe-ish foods.
Your ideas are patently false, and I want you off my thread, you already hijacked it and took it off topic.
Posted by Robert_Burton_1621 on July 24, 2015, at 11:32:29
In reply to Re: Lou's urgent request-ehvahdenz » Lou Pilder, posted by Uncouth on July 24, 2015, at 10:49:16
Posted by 10derheart on July 24, 2015, at 13:04:16
In reply to Re: Lou's urgent request ** Bravo Uncouth (nm) » Uncouth, posted by Robert_Burton_1621 on July 24, 2015, at 11:32:29
Posted by Lou Pilder on July 24, 2015, at 14:09:56
In reply to Re: Lou's urgent request-ehvahdenz » Lou Pilder, posted by Uncouth on July 24, 2015, at 10:49:16
> Who the f*ck do you think you are?
> Get off this site.
>
> If you actually read the references others have pointed to you would realize that a combination of an MAOI and an NRI is not only not dangerous, it is a potent and important combination for treatment resistant depression and, I will repeat what others have said, 'LOU', MAKES MAOIs SAFER AS IT SEVERELY ATTENUATES HYPERTENSIVE CRISES AS A RESULT OF TYRAMINE INGESTION.
>
> Note that ever since I have started the atomoxetine and hit a stable and reasonable dose of 80mg, I have had no problems eating whatever I wantaged cheeses, meats, fermented foods, etc. with ZERO and I mean ZERO BP effects. Before the parnate, I would often feel transient and brief increases in BP from small levels of tyramine in even normal or safe-ish foods.
>
> Your ideas are patently false, and I want you off my thread, you already hijacked it and took it off topic.Friends,
Be not deceived by statements that are allowed to be seen here as being supportive by Mr. Hsiung and deputy of record. My "ideas" are not false at all, for the use of Parnate with Strattera could cause death by internal bleeding in the brain due to increased blood pressure caused by Parnate.
You see, when Parnate was first prescribed, there were deaths from internal bleeding in the brain and the drug was withdrawn from the market because of that. Then the manufacturer lowered the dose for prescribing in order to re market their drug. So the cause of the deaths was too much of the drug. That leads to why Strattera is contraindicated in combining with Parnate. Now contraindicated means "never" together in the medical terminology of drug interactions combining drugs. You see, when psychotropic drugs are combined, the effects are increased exponentially. So when Parnate is combined with Strattera, the effects of Parnate are increased exponentially. So what happens is that the amount of Parnate then goes to the prohibited amount that is too much and can cause death via internal bleeding in the brain like the original dosage that was recalled and taken off the market.
Now you mothers. Look at where the evidence is that the poster says that there is that the combining of the two drugs will be safe. Can you see it? I can't. Do you want to use anecdotal remarks by the poster that wants to advocate that my "ideas" are patently false? Whose ideas are false can be determined by the conclusions made by counting the dead that took the drugs in combination. Do you want your child to be counted in the dead by giving him/her this lethal combination of drugs in collaboration with a psychiatrist/doctor that would prescribe such? The poster here wants to know who I am. (Who is he/she?) Does that really matter in your decision to drug your child or not. I say to you, that if you heed my advise and look at the following link, and still drug your child like those here advocate and your child dies from the drugs, your child's blood will not be upon me.
Lou
http://www.drugs.com/strattera.html
Posted by SLS on July 24, 2015, at 15:54:02
In reply to Lou's urgent request to readers-huizhe » Uncouth, posted by Lou Pilder on July 24, 2015, at 14:09:56
Mr. Pilder.
Your research seems to be incomplete. Please review the following article with special attention paid to the quoted passages. You simply do not know enough to go out of your way to scare people. I think it would be more supportive to the community if you would match your tone to your level of knowledge.
- Scott----------------------------------------------------
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2014120/
"The data indicate that nortriptyline and desipramine have the most pharmacologically desirable characteristics as noradrenaline reuptake inhibitors (NRIs), and as drugs with few interactions that are also safe when coadministered with either MAOIs or SSRIs."
"When tyramine is administered intravenously, blood pressure increases and this response is greatly potentiated by MAOIs. Tyramine utilizes, and requires, the NAT to enter the pre-synaptic terminal, where it then induces depolarization-independent release of NA. NRIs inhibit tyramine uptake and thus attenuate the response, which gives an in vivo measure of their NRI potency: indeed the NRIs with the highest affinity for the NAT (reboxetine, desipramine and nortriptyline; Table 3) have all been demonstrated to block this response almost completely, even when it has been potentiated in the presence of MAOIs"
----------------------------------------------------
Posted by Lou Pilder on July 24, 2015, at 17:09:39
In reply to Scaring people without sufficient knowledge. » Lou Pilder, posted by SLS on July 24, 2015, at 15:54:02
> Mr. Pilder.
>
> Your research seems to be incomplete. Please review the following article with special attention paid to the quoted passages. You simply do not know enough to go out of your way to scare people. I think it would be more supportive to the community if you would match your tone to your level of knowledge.
>
>
> - Scott
>
> ----------------------------------------------------
>
> http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2014120/
>
> "The data indicate that nortriptyline and desipramine have the most pharmacologically desirable characteristics as noradrenaline reuptake inhibitors (NRIs), and as drugs with few interactions that are also safe when coadministered with either MAOIs or SSRIs."
>
> "When tyramine is administered intravenously, blood pressure increases and this response is greatly potentiated by MAOIs. Tyramine utilizes, and requires, the NAT to enter the pre-synaptic terminal, where it then induces depolarization-independent release of NA. NRIs inhibit tyramine uptake and thus attenuate the response, which gives an in vivo measure of their NRI potency: indeed the NRIs with the highest affinity for the NAT (reboxetine, desipramine and nortriptyline; Table 3) have all been demonstrated to block this response almost completely, even when it has been potentiated in the presence of MAOIs"
>
> ----------------------------------------------------
> Friends,
It is written here about my character that could decrease the respect, regard and confidence in which I am held and induce hostile and disagreeable opinions and feelings against me if readers think that the statement by Scott that I do not know enough is taken as truth. You see, I do know enough and have the training to understand that there is a scientific basis for knowing that there could be death as a result of combining Parnate with Strattera because the combination could raise the blood level of Parnate that could cause internal bleeding of the brain and kill the person. The two together are contraindicated and I could not believe that a psychiatrist could not know that. This means that those that advocate the taking of both drugs in combination could be ignorant of the fact that taking the combination could cause death. But a psychiatrist prescribing such a combination has a standard of what they should know since they hold a certificate stating that they are approved by some university to practice such.
Now the citation by Scott is concerning some tri-cyclic chemicals called antidepressants. This is not what the discussion concerns, for the discussion is about the interaction of Parnate and Strattera. Be not deceived here. For many will come deriding me here and saying that I do not know enough to write what I write and they could come in sheep's clothing but inwardly they could be ravening wolves, all allowed by Mr. Hsiung to post against my character with impunity. That could IMHO cause life-ruining conditions and addictions and deaths from reading here because what is not sanctioned by Mr. Hsiung is not against his rules and being supportive takes precedence according to him so that as you read what Scott has posted here about me unsanctioned, you could take Scott at his word even though what he has posted is not relevant to this discussion, and think that I do not know enough, but I do and I do and I do.
And those of you that are going to accept Scott's portrayal of me as a person not knowing enough, and go ahead and take Parnate with Strattera, and are killed by the combination, it will be too late for you to think that you should have known better, and your blood will not be upon me.
Lou
Posted by Robert_Burton_1621 on July 24, 2015, at 17:57:22
In reply to Lou's response-shdahnownbedur, posted by Lou Pilder on July 24, 2015, at 17:09:39
> > Mr. Pilder.
> >
> > Your research seems to be incomplete. Please review the following article with special attention paid to the quoted passages. You simply do not know enough to go out of your way to scare people.
> >
> >
> > - Scott
> >
> > ----------------------------------------------------
> >
> > http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2014120/
> >
> > "The data indicate that nortriptyline and desipramine have the most pharmacologically desirable characteristics as noradrenaline reuptake inhibitors (NRIs), and as drugs with few interactions that are also safe when coadministered with either MAOIs or SSRIs."
> >
> > "When tyramine is administered intravenously, blood pressure increases and this response is greatly potentiated by MAOIs. Tyramine utilizes, and requires, the NAT to enter the pre-synaptic terminal, where it then induces depolarization-independent release of NA. NRIs inhibit tyramine uptake and thus attenuate the response, which gives an in vivo measure of their NRI potency: indeed the NRIs with the highest affinity for the NAT (reboxetine, desipramine and nortriptyline; Table 3) have all been demonstrated to block this response almost completely, even when it has been potentiated in the presence of MAOIs"
> >
> > ----------------------------------------------------> Now the citation by Scott is concerning some tri-cyclic chemicals called antidepressants. This is not what the discussion concerns, for the discussion is about the interaction of Parnate and Strattera. Be not deceived here...
> And those of you that are going to accept Scott's portrayal of me as a person not knowing enough, and go ahead and take Parnate with Strattera, and are killed by the combination, it will be too late for you to think that you should have known better, and your blood will not be upon me.
> LouScott's description is accurate and objective. Your above post confirms it. The tricyclic medications which act as noradrenaline reputable inhibitors are many times more potent that strattera (whose pharmacological action is as an NRI). Why would it be safe to co-administer nortiptyline with tranylcypromine but not atomoxetine?
Your knowledge of MAOIs and their potential interactions is totally outdated, and inaccurate. The early reports of SAH deaths from MAOIs involved the consumption of tyramine-rich food like blue cheese, the combination of amphetamines with MAOIs, and serotonin toxicity when combined with serotonergic medications or extremely high levels of supplements (tryptophan).
Strattera is *not* a "stimulant" in the sense that, for instance, dextroamphetamine is.
If you cannot draw correct inferences from research which classifies medications by reference to their structure rather than pharmacological action (some "tricyclics" are just as much "serotonin reuptake inhibitors" as SSRIs - you are entirely mislead, and wrong, by thinking in terms of nominal categorisation), note these papers:
http://www.ncbi.nlm.nih.gov/pubmed/3997787
http://www.ncbi.nlm.nih.gov/pubmed/25884531
http://www.ncbi.nlm.nih.gov/pubmed/19067263
http://www.ncbi.nlm.nih.gov/pubmed/10901349
http://www.ncbi.nlm.nih.gov/pubmed/2710808?dopt=Abstract
http://www.ncbi.nlm.nih.gov/pubmed/24972362
I would like to echo Scott's admonishment: your persistence in alarming someone who is already in a difficult situation, without first fully assessing critically the cogency and accuracy of your warnings, is unjustifiable and very wrong.
Posted by SLS on July 24, 2015, at 18:58:31
In reply to Lou's response-shdahnownbedur, posted by Lou Pilder on July 24, 2015, at 17:09:39
Strattera = atomoxetine
http://www.ncbi.nlm.nih.gov/pubmed/15554766
"A MEDLINE search was conducted for articles published from 1962 to December 2003 using relevant search terms (psychostimulant, stimulant, amphetamine, dextroamphetamine, pemoline or methylphenidate, atomoxetine, bupropion, monoamine oxidase inhibitor, and selegiline)."
"No documented reports were found in the recent literature of hypertensive crises or fatalities occurring when the stimulant was cautiously added to the MAOI."
I performed my own searches and was unable to find a single case of adverse reaction attributable to the combination of Strattera (atomoxetine) with tranylcypromine. It is understandable that the drug company for Strattera (Lilly) would want to unconditionally contraindicate combinations of its drug with MAOIs. Older medical literature clinged to the notion that one could not combine MAOIs with any other antidepressant or stimulant. In real life, this has since been shown to be erroneous. The most important adverse reactions occur with drugs that potentiate serotonin neurotransmission, such as SSRIs and SNRIs. This includes the tricyclics: imipramine and clomipramine.
Also:
http://www.ncbi.nlm.nih.gov/pubmed/7931221
"These results suggest that reboxetine might be advantageously combined with tranylcypromine, or any MAO inhibitor..."
- Scott
Posted by SLS on July 24, 2015, at 19:04:17
In reply to Re: Lou's urgent request-ehvahdenz » Lou Pilder, posted by Uncouth on July 24, 2015, at 10:49:16
Hi Uncouth.
Where are you at with things right now?
Will you be discontinuing Parnate?
Do you have any questions on what to expect?
- Scott
Posted by Lou Pilder on July 24, 2015, at 19:26:01
In reply to Re: Lou's response-shdahnownbedur, posted by Robert_Burton_1621 on July 24, 2015, at 17:57:22
> > > Mr. Pilder.
> > >
> > > Your research seems to be incomplete. Please review the following article with special attention paid to the quoted passages. You simply do not know enough to go out of your way to scare people.
> > >
> > >
> > > - Scott
> > >
> > > ----------------------------------------------------
> > >
> > > http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2014120/
> > >
> > > "The data indicate that nortriptyline and desipramine have the most pharmacologically desirable characteristics as noradrenaline reuptake inhibitors (NRIs), and as drugs with few interactions that are also safe when coadministered with either MAOIs or SSRIs."
> > >
> > > "When tyramine is administered intravenously, blood pressure increases and this response is greatly potentiated by MAOIs. Tyramine utilizes, and requires, the NAT to enter the pre-synaptic terminal, where it then induces depolarization-independent release of NA. NRIs inhibit tyramine uptake and thus attenuate the response, which gives an in vivo measure of their NRI potency: indeed the NRIs with the highest affinity for the NAT (reboxetine, desipramine and nortriptyline; Table 3) have all been demonstrated to block this response almost completely, even when it has been potentiated in the presence of MAOIs"
> > >
> > > ----------------------------------------------------
>
> > Now the citation by Scott is concerning some tri-cyclic chemicals called antidepressants. This is not what the discussion concerns, for the discussion is about the interaction of Parnate and Strattera. Be not deceived here...
> > And those of you that are going to accept Scott's portrayal of me as a person not knowing enough, and go ahead and take Parnate with Strattera, and are killed by the combination, it will be too late for you to think that you should have known better, and your blood will not be upon me.
> > Lou
>
> Scott's description is accurate and objective. Your above post confirms it. The tricyclic medications which act as noradrenaline reputable inhibitors are many times more potent that strattera (whose pharmacological action is as an NRI). Why would it be safe to co-administer nortiptyline with tranylcypromine but not atomoxetine?
>
> Your knowledge of MAOIs and their potential interactions is totally outdated, and inaccurate. The early reports of SAH deaths from MAOIs involved the consumption of tyramine-rich food like blue cheese, the combination of amphetamines with MAOIs, and serotonin toxicity when combined with serotonergic medications or extremely high levels of supplements (tryptophan).
>
> Strattera is *not* a "stimulant" in the sense that, for instance, dextroamphetamine is.
>
> If you cannot draw correct inferences from research which classifies medications by reference to their structure rather than pharmacological action (some "tricyclics" are just as much "serotonin reuptake inhibitors" as SSRIs - you are entirely mislead, and wrong, by thinking in terms of nominal categorisation), note these papers:
>
> http://www.ncbi.nlm.nih.gov/pubmed/3997787
>
> http://www.ncbi.nlm.nih.gov/pubmed/25884531
>
> http://www.ncbi.nlm.nih.gov/pubmed/19067263
>
> http://www.ncbi.nlm.nih.gov/pubmed/10901349
>
> http://www.ncbi.nlm.nih.gov/pubmed/2710808?dopt=Abstract
>
> http://www.ncbi.nlm.nih.gov/pubmed/24972362
>
> I would like to echo Scott's admonishment: your persistence in alarming someone who is already in a difficult situation, without first fully assessing critically the cogency and accuracy of your warnings, is unjustifiable and very wrong.Friends,
Be not deceived. Just because they say that I am wrong here, and just because they say that I don't know. And just because they say that my statements are inaccurate, that does not mean that they are.
You see, the two posters here in concert together to advocate taking Parnate with Strattera together attempt to make readers believe that there is research to substantiate their claim, which taking the two together could cause death via bleeding of the brain. Their attempt to substantiate their claim comes from that Parnate and some tri cyclic antidepressant drugs and stimulant drugs have been used by prescribers. But if you read their citations carefully, Strattera is not one of the drugs mentioned. In fact, Strattera has an un usual classification from its chemical structure. And if it fits in one class of tri cyclics, that does not mean that it is safe just because another tricyclic or stimulant was used. You see, Strattera is not like Ritalin or Adderall in it's chemical composition. It is a different drug from them and to use them when other drugs are the ones mentioned in their citations, jumps to a conclusion that Strattera is the same and it is not related chemically, it is a different drug and the citations mention specific tri cyclic antidepressants, not all.
Now I know that you folks are the right kind of people. I want to be perfectly frank. You got one, two, three, four, five, six posters here against me, posters that could mark the difference between you being a live person or a corpse for what they say about me could be considered to be supportive by Mr. Hsiung since it stands to be seen that way.
This could IMHHHHO set up a collective psychopathy here. A psychopathy that could lead you to your deaths. For the taking of Parnate with Strattera is contraindicated by the medical profession and in the citations offered here, there is no denying that. There is some snake-oil that when taken it is harmless. But there could be other snake-oil that could lead to addiction and life-ruining conditions and death. Which snake-oil will one take? The one being hawked by the panderers of such could be suspect. But if there is research showing that taking Parnate with Strattera is contraindicated, that could help you make a more-informed decision.
Here is a link showing that taking Parnate with Strattera is contraindicated.
Lou
https://online.epocrates.com/u/1043283/Strattera/Drug+Interactions
Posted by Lou Pilder on July 24, 2015, at 19:41:08
In reply to Read. » Lou Pilder, posted by SLS on July 24, 2015, at 18:58:31
> Strattera = atomoxetine
>
> http://www.ncbi.nlm.nih.gov/pubmed/15554766
>
> "A MEDLINE search was conducted for articles published from 1962 to December 2003 using relevant search terms (psychostimulant, stimulant, amphetamine, dextroamphetamine, pemoline or methylphenidate, atomoxetine, bupropion, monoamine oxidase inhibitor, and selegiline)."
>
> "No documented reports were found in the recent literature of hypertensive crises or fatalities occurring when the stimulant was cautiously added to the MAOI."
>
> I performed my own searches and was unable to find a single case of adverse reaction attributable to the combination of Strattera (atomoxetine) with tranylcypromine. It is understandable that the drug company for Strattera (Lilly) would want to unconditionally contraindicate combinations of its drug with MAOIs. Older medical literature clinged to the notion that one could not combine MAOIs with any other antidepressant or stimulant. In real life, this has since been shown to be erroneous. The most important adverse reactions occur with drugs that potentiate serotonin neurotransmission, such as SSRIs and SNRIs. This includes the tricyclics: imipramine and clomipramine.
>
> Also:
>
> http://www.ncbi.nlm.nih.gov/pubmed/7931221
>
> "These results suggest that reboxetine might be advantageously combined with tranylcypromine, or any MAO inhibitor..."
>
>
> - Scott
Scott,
I read that and Strattera is not a stimulant according to my research. In other studies it was Ritalin and Adderall that were cited. And anyway, the article admits that the treatment has risks and just because in their search they did not find deaths, that does not mean that the combination is not contraindicated, for it is and the study was from years ago and there is new additional information available today that was unbeknownst to then. And readers, if taking a combination of drugs is contraindicated, that means the combination is not to be prescribed. I agree that in cases where there is no hope, like last stage cancer, any treatment could be used for there is nothing to loose. But now there are oncologists that do not use chemo in end stage cancer because it could make the patient worse. If there are psychiatrists still using Parnate with Strattera, I do not know of any reports of such in the present. I agree that there could be those in 2003 and such. But that was one-upon-a-time, and once-upon-a-time I havn't seen to come again.
If you want readers to take the two drugs together, if they die from the drugs, their blood will not be upon me.
Lou
Posted by Lou Pilder on July 24, 2015, at 21:10:31
In reply to Lou's reply-wuncuponehytym » SLS, posted by Lou Pilder on July 24, 2015, at 19:41:08
> > Strattera = atomoxetine
> >
> > http://www.ncbi.nlm.nih.gov/pubmed/15554766
> >
> > "A MEDLINE search was conducted for articles published from 1962 to December 2003 using relevant search terms (psychostimulant, stimulant, amphetamine, dextroamphetamine, pemoline or methylphenidate, atomoxetine, bupropion, monoamine oxidase inhibitor, and selegiline)."
> >
> > "No documented reports were found in the recent literature of hypertensive crises or fatalities occurring when the stimulant was cautiously added to the MAOI."
> >
> > I performed my own searches and was unable to find a single case of adverse reaction attributable to the combination of Strattera (atomoxetine) with tranylcypromine. It is understandable that the drug company for Strattera (Lilly) would want to unconditionally contraindicate combinations of its drug with MAOIs. Older medical literature clinged to the notion that one could not combine MAOIs with any other antidepressant or stimulant. In real life, this has since been shown to be erroneous. The most important adverse reactions occur with drugs that potentiate serotonin neurotransmission, such as SSRIs and SNRIs. This includes the tricyclics: imipramine and clomipramine.
> >
> > Also:
> >
> > http://www.ncbi.nlm.nih.gov/pubmed/7931221
> >
> > "These results suggest that reboxetine might be advantageously combined with tranylcypromine, or any MAO inhibitor..."
> >
> >
> > - Scott
> Scott,
> I read that and Strattera is not a stimulant according to my research. In other studies it was Ritalin and Adderall that were cited. And anyway, the article admits that the treatment has risks and just because in their search they did not find deaths, that does not mean that the combination is not contraindicated, for it is and the study was from years ago and there is new additional information available today that was unbeknownst to then. And readers, if taking a combination of drugs is contraindicated, that means the combination is not to be prescribed. I agree that in cases where there is no hope, like last stage cancer, any treatment could be used for there is nothing to loose. But now there are oncologists that do not use chemo in end stage cancer because it could make the patient worse. If there are psychiatrists still using Parnate with Strattera, I do not know of any reports of such in the present. I agree that there could be those in 2003 and such. But that was one-upon-a-time, and once-upon-a-time I havn't seen to come again.
> If you want readers to take the two drugs together, if they die from the drugs, their blood will not be upon me.
> Lou
>
Friends,
The urgency here is that I am afraid that you will discount what I post as per my adversaries here posting what could decrease the respect and regard and confidence in which I am held and induce hostile and disagreeable opinions and feelings toward me.
I say this with shame, for I am appalled that these hatefull messages here are allowed to be posted about me and that the citations could influence you to take a deadly combination of drugs. And not only is the combination one that could kill you, but by themselves, the drugs are dangerous to human beings all allowed to be promoted here as "medicines" and the posting is supportive.
You see, Strattera was not on the market in the U.S. until 2006. That is not in the citations by my adversaries here to influence you. And the suicidal thinking risk with Strattera is high comparatively as almost 4%. And some of the chemicals in Strattera are illegal in many countries. You see, the drug (redacted by respondent) and is used to keep dogs from urinating. Do you want to take this (redacted by respondent)?
Lou
Posted by SLS on July 24, 2015, at 21:11:26
In reply to Lou's reply-wuncuponehytym » SLS, posted by Lou Pilder on July 24, 2015, at 19:41:08
I will agree that the abstract did not say explicitly, "atomoxetine can be combined safely with tranylcypromine". It is unfortunate that the full article is not available to scrutinize. The authors listed atomoxetine and bupropion as drugs included in their research of stimulants. If they had found an adverse event with either of these two drugs, I imagine they would have reported it. I am not sure of their rationale, but they grouped together atomoxetine and bupropion with drugs that are routinely described as being "stimulants". Both drugs, are, however, NE reuptake inhibitors (NRI) that are useful in treating ADD / ADHD and have properties in common with methylphenidate.
* As per the article:
Stimulant = amphetamine, dextroamphetamine, pemoline or methylphenidate, atomoxetine, bupropion
"No documented reports were found in the recent literature of hypertensive crises or fatalities occurring when the stimulant [amphetamine, dextroamphetamine, pemoline or methylphenidate, atomoxetine, bupropion] was cautiously added to the MAOI."
That's the way I interpreted the abstract.
Do you know of anyone who has taken atomoxetine and tranylcypromine together? Were there any fatal reactions?
Which tricyclic antidepressants are safe to take with MAO inhibitors?
- Scott
Posted by SLS on July 24, 2015, at 21:45:16
In reply to Lou's reply-urgent, posted by Lou Pilder on July 24, 2015, at 21:10:31
It is unfortunate that you place yourself in the position of adversary. I'm sure people would rather treat you as a colleague who dissents against the consensus. However, you refuse to work "with" people. You never communicate with others in the form of a dialogue. You prefer to remain dogmatic in your presentation. This is a shame. You are certainly intelligent enough to understand much of the material being discussed here. You just don't seem to be motivated enough to seek facts and theories beyond those that attempt to prove your thesis and agenda.
Because you interrupt and hijack other people's threads, you have become a pariah. If you want to stimulate true discourse, I recommend that you start your own threads with descriptive subject titles. Ask for honest feedback from others that you consider honestly for yourself. The Socratic Dialogue works well. If you communicate personally with other people in a true dialogue, respect will come easily to you, and you are much more likely to effect change.
- Scott
Posted by SLS on July 24, 2015, at 22:08:46
In reply to Re: Stopping Parnate for surgery? Help! » Uncouth, posted by Uncouth on July 23, 2015, at 11:26:19
> I will be tapering down Parnate by 10mg/day over the next 13 days.
That sounds like a good idea.
Some of the withdrawal symptoms you may experience include: great fatigue, REM rebound dreaming, depressive rebound symptomatology (worse than original depression), anxiety, somnolence, impaired concentration, dizziness, weakness, headaches, and diarrhea, among others.
Increasing the dosage of Abilify to 5.0 mg/day is a reasonable choice. You might also ask your doctors if taking a benzodiazepine now to reduce the anxiety and act as a bridge until you can restart the Parnate makes sense. Have you thought to replace Strattera with nortriptyline? I'll have to brainstorm this thing more.
I am sure that others will offer better ideas than mine.
Good luck.
- Scott
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