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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by Laurie on September 22, 1999, at 13:58:39
Hi, I'm new here so please forgive (and correct) me if my ettiquette is lacking.
My phychiatrist told me he would like to try me on either Nardil or Parnate and told me that if I wanted to have a better involvement in my treatment that I should research them on the internet. So far what I have seen of either (indications, contra-indications, etc.) quite frankly, scare me. I am currently taking Flovent and (occasionally Ventolin) for asthma and Flonase for a chronic allergy problem which is immune to antihistamines. My problem is this; from what I have read, if I understand correctly, with my asthma and allergy meds, Parnate should not even be an option. Nardil doesn't seem to contra-indicate these meds but there is a possibility of some very scary side-effects with both. Also, less importantly though still a concern, weight gain is mentioned as a common side-effect for the Nardil. I am beginning to lose hope that I can ever be successfully treated! I have already, in the distant and near past, been through Prozac, Effexor, Serzone, Amytriptaline, and Zoloft.
Zoloft was the only one to show a marked impact of a positive nature and I developed an immunity to it only somewhat mre slowly than I have to all antihistamines and painkillers to which I've been exposed in the past.
I don't know what to tell my Dr. when I see him except, perhaps, that I fear I may be medicinally un-treatable. Is there an option out there that I don't know about or, am I, once again, over-reacting? Please, someone, help?
Posted by Mike on September 23, 1999, at 13:45:40
In reply to Drug interaction (specifically Parnate or Nardil , posted by Laurie on September 22, 1999, at 13:58:39
> Hi, I'm new here so please forgive (and correct) me if my ettiquette is lacking.
> My phychiatrist told me he would like to try me on either Nardil or Parnate and told me that if I wanted to have a better involvement in my treatment that I should research them on the internet. So far what I have seen of either (indications, contra-indications, etc.) quite frankly, scare me. I am currently taking Flovent and (occasionally Ventolin) for asthma and Flonase for a chronic allergy problem which is immune to antihistamines. My problem is this; from what I have read, if I understand correctly, with my asthma and allergy meds, Parnate should not even be an option. Nardil doesn't seem to contra-indicate these meds but there is a possibility of some very scary side-effects with both. Also, less importantly though still a concern, weight gain is mentioned as a common side-effect for the Nardil. I am beginning to lose hope that I can ever be successfully treated! I have already, in the distant and near past, been through Prozac, Effexor, Serzone, Amytriptaline, and Zoloft.
> Zoloft was the only one to show a marked impact of a positive nature and I developed an immunity to it only somewhat mre slowly than I have to all antihistamines and painkillers to which I've been exposed in the past.
> I don't know what to tell my Dr. when I see him except, perhaps, that I fear I may be medicinally un-treatable. Is there an option out there that I don't know about or, am I, once again, over-reacting? Please, someone, help?I think there are a couple of issues you and your psychiatrist should sort through. First, if he was not able or unwilling to provide you with the information you need on MAO inhibitors, such as Nardil or Parnate, then I would switch psychiatrists. You can likely find a knowledgable psychopharmacologist at a University based Anxiety Disorders Clinic. Second, I'm not sure of the condition for which you're seeking treatment. Is is social phobia or panic? Third, if it is one of these, then Nardil (Phenelzine) and Parnate (Tranylcypromine) could be appropriate. Nardil is usually almost 100% effective. However, weight gain is common, as it is with many of the SSRI (Selective Serotonin Re-uptake Inhibitors). With Parnate, weight gain is not a problem (frequently there's some weight loss). However, there's much less out there in terms of controlled studies showing efficacy in treating social phobia or panic. Also, it's structure is different from Nardil. Nardil is a hydrazine (therefore affects GABA levels) and Parnate is not a hydrazine. I'm just mentioning this as a reaon for differences in therapeutic effect and side effect profile. Third, the dietary restrictions, in my opinion, are somewhat overblown. Definitely avoid red wine and aged meat and aged cheeses, for instance. The medical contraindications are more important. Most cold and allergy medications are a no-no. Your pharmacist could tell you based upon what you're taking if MAOI's are contraindicated. Fourth, you have another alternative in terms of benzodiazepines. Klonopin (Clonazepam), for example, has been shown to be highly effective in long-term treatment of social phobia and panic. It also has not been subject to abuse. You can take it up to 10 mg/day, but more common dosages for social phobia and panic would be 2.0 to 3.0 mg/day.
Good luck and, if I were you, I would likely consider switching psychiatrists.
Posted by Bob on September 23, 1999, at 14:23:33
In reply to Re: Drug interaction (specifically Parnate or Nardil , posted by Mike on September 23, 1999, at 13:45:40
Laurie, who's your pharmacist?
If you use one of the larger chain drug stores, the all have these computer database systems that match your meds for known interactions. Geez--before my recent move, I was going to a Walgreens and boy howdy did their system have a hair trigger! It was red flagging pairs of meds for me on drug interactions that were, in a few cases, exactly the reason why my pdoc put me on those two meds!
It's just one more information source, to cross-check against any others. Your pdoc *should* know about interactions of psychotropics with commonly prescribed meds or common over-the-counter meds. So should your pharmacist. But these computer systems are a great safety net ... they may be billed as a consumer resource, but I'm sure they also cut their corporate legal expenses considerably as well. Every intercepted interaction means one less potential law suit.
Go to your pharmacist. Ask her to runs those ADs against your asthma/allergy meds and see what the computer spits out. If you go to a local, independent pharmacy without such a system, go to one of the chains ... ask if they'd run the check for you.
Cheers,
Bob
Posted by Laurie on September 24, 1999, at 14:15:10
In reply to Re: Drug interaction (specifically Parnate or Nardil , posted by Mike on September 23, 1999, at 13:45:40
> I think there are a couple of issues you and your psychiatrist should sort through. First, if he was not able or unwilling to provide you with the information you need on MAO inhibitors, such as Nardil or Parnate, then I would switch psychiatrists. You can likely find a knowledgable psychopharmacologist at a University based Anxiety Disorders Clinic.Actually, this IS a new p-doc. I don't think he was unwilling to give me the info, I think he was trying to help me feel more in control (or at least more contributive to) my own treatment. I was very upset when I went through some very unpleasant withdrawal symptoms while coming off the Effexor because my previous p-doc gave me no warnings of this aspect of the drug when he prescribed it.
Second, I'm not sure of the condition for which you're seeking treatment.
Actually, I should've mentioned that I'm being treated for atypical chronic depression. In fact, I was surprised when I saw that these 2 meds were used for social phobia and/or anxiety. I suppose that some anxiety is included in my depression symptoms but I did read that these meds were also used for atypical (read unresponsive to traditional meds) depression. My problem in the past is that I build up immunities to drugs very quickly. A good example is how, while in labour with my child, I found the epidural wearing off too quickly (about 2 hours) and when they "topped it off" the second dose had no effect at all. (No exaggeration, honest!) They then used what the OB-GYN called "a block" so he could use forceps and that also had no effect at all. I'm the same with painkillers (demerol, codiene) and there hasn't been an antihistamine on the market that helped me for 20 years now. (I've usually gotten it by prescription before it went over the counter and it's lost any effectiveness by the time it was.)
Zoloft was WONDERFUL!... for about 4 months. After that, even upping the dose did nothing. All my old p-doc did when I said that Effexor wasn't helping was reduce the dose and put me on Manerix as well, to no effect. If I can build up my immunities like this (it runs in the family, I even out grew a bee sting allergy) is there anything that I CAN take indefintitely?
Posted by Laurie on September 24, 1999, at 14:17:26
In reply to Re: Drug interaction (specifically Parnate or Nardil , posted by Bob on September 23, 1999, at 14:23:33
> If you use one of the larger chain drug stores, the all have these computer database systems that match your meds for known interactions.
Good idea! Never even occurred to me, I'll try it, thanks!
Posted by jd on September 24, 1999, at 20:26:19
In reply to Re: Drug immunities (answer to Mike), posted by Laurie on September 24, 1999, at 14:15:10
Hi Laurie,
You're right that MAOIs are often used for atypical depression or in depression that hasn't responded to other treatments. These are actually two different things, though: "atypical" usually refers to depressions characterized by certain specific features like overeating, oversleeping, and a number of others. (There's much more complete information in some previous month's postings.)As you note, I'd be *very* careful mixing MAOIs with any medications whatsoever: they can be great meds for some people, but you do need to be very careful about your diet and other medecines if you take them. Some meds are OK to mix them, but many are definite no-no's.... From what you say about previous meds "pooping out" on you after several months, I might also suggest that you or your p-doc look into the opiate-blocking med called naltrexone as an additional option. Many people have tried it as an add-on medication to drugs like Zoloft in recent months, and it's apparently been very successful with some people who've had chronic problems that have never responded long-term to other treatments. See my mosting a few lines above, for example...
Good luck to you, whatever your and your p-doc's final decision,
JD> > Actually, I should've mentioned that I'm being treated for atypical chronic depression. In fact, I was surprised when I saw that these 2 meds were used for social phobia and/or anxiety. I suppose that some anxiety is included in my depression symptoms but I did read that these meds were also used for atypical (read unresponsive to traditional meds) depression. My problem in the past is that I build up immunities to drugs very quickly. A good example is how, while in labour with my child, I found the epidural wearing off too quickly (about 2 hours) and when they "topped it off" the second dose had no effect at all. (No exaggeration, honest!) They then used what the OB-GYN called "a block" so he could use forceps and that also had no effect at all. I'm the same with painkillers (demerol, codiene) and there hasn't been an antihistamine on the market that helped me for 20 years now. (I've usually gotten it by prescription before it went over the counter and it's lost any effectiveness by the time it was.)
> Zoloft was WONDERFUL!... for about 4 months. After that, even upping the dose did nothing. All my old p-doc did when I said that Effexor wasn't helping was reduce the dose and put me on Manerix as well, to no effect. If I can build up my immunities like this (it runs in the family, I even out grew a bee sting allergy) is there anything that I CAN take indefintitely?
This is the end of the thread.
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