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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by ryan_s on February 17, 2000, at 0:31:29
i have tried almost all of the ssri's with no avail and want to try an maoi, but first i have some questions on its effectiveness. if someone has had any experience with marplan, nardil, or parnate, please reply to this message. first, do the maoi's numb emotions like the ssri's? second, can maoi's be combined with zyprexa or seroquel? third, do the maoi's, in general, have the reputation of producing a sense of well being in the patient. fourth, if you have tried nardil, parnate, or marplan, which do you prefer. please tell of your experiences with maoi's, because i am all ears. write your heart out. a response will be greatly appreciated. hopefully the maoi's will give put me in the right direction in life.
ryan
Posted by torchgrl on February 17, 2000, at 1:00:15
In reply to maoi or bust, posted by ryan_s on February 17, 2000, at 0:31:29
Ryan,
SSRIs are really the meds that are most notorious for inducing apathy--I don't remember reading about anyone's experience with MAOIs causing the same thing.
Obviously, if the med is working, it will induce something of a feeling of wellbeing--if it feels like you're on something illicit, that may not be a good thing in the long run, though!
MAOIs have often proved THE medication for people who seem to be resistant to everything else, or who have atypical symptoms. The main issue seems to be the high potential for interaction with certain foods and other medications--I'm not sure about antipsychotics/mood-stabilisers, though.I've only tried Parnate, and had to quit because of unnerving side effects that, in retrospect, were probably exacerbated by my low blood-pressure. At first, it really affected my sleep and killed my appetite, but that only lasted about a week/10 days. I didn't want to try Nardil because you're pretty much guaranteed to gain some weight on that one.
There seems to be a consensus around here that a lot of the food warnings are overly cautious, but there are still certain things you have to steer clear/be aware of; as long as you're willing to do so, though, it's definitely worth trying them out--as a class, they seem to be really underutilised. Good luck!
Posted by jd on February 18, 2000, at 1:37:38
In reply to maoi or bust, posted by ryan_s on February 17, 2000, at 0:31:29
Hi Ryan,
I was one of the people who replied to your original post about finding a pdoc willing to prescribe MAOIs. (As I said there, any pdoc who is really experienced with refractory depression will likely consider them useful meds for many patients.) Because they affect many neurotransmitter systems at once (particularly dopamine), MAOIs are probably far less likely to cause the "emotional numbness" associated with SSRIs. As for distinctions between the individual MAOIs, Nardil is often considered as the best for people who have significant anxiety--the major drawback is the weight gain it very often causes. (This can be a real dilemma, because Nardil can be extremely effective for some people who respond to nothing else.) On the other extreme is Parnate, which is usually considered the most activating and energizing--it rarely causes weight gain, but it's probably not the best first choice for people with insomnia or serious anxiety. Marplan is often said to be somewhere *between* Nardil and Parnate, though it's perhaps a bit closer to Nardil on most counts. (It's not as well-known a med as Parnate or Nardil.) As for your other question about combining MAOIs with meds like zyprexa or seroquel, this is probably not done very often, but I don't think it's completely off-limits the way SSRIs are in combination. I have seen one reference to nardil being used along with risperdal, which is more or less in the same class as the meds you mention. Combining such meds with an MAOI is a pretty delicate art, so a pdoc will probably be reluctant to try it unless there is a very compelling reason.Hope all goes well for you finding a pdoc responsive to your needs and concerns!
best,
jd
> i have tried almost all of the ssri's with no avail and want to try an maoi, but first i have some questions on its effectiveness. if someone has had any experience with marplan, nardil, or parnate, please reply to this message. first, do the maoi's numb emotions like the ssri's? second, can maoi's be combined with zyprexa or seroquel? third, do the maoi's, in general, have the reputation of producing a sense of well being in the patient. fourth, if you have tried nardil, parnate, or marplan, which do you prefer. please tell of your experiences with maoi's, because i am all ears. write your heart out. a response will be greatly appreciated. hopefully the maoi's will give put me in the right direction in life.
>
> ryan
Posted by JohnL on February 19, 2000, at 4:09:56
In reply to maoi or bust, posted by ryan_s on February 17, 2000, at 0:31:29
Ryan,
I have not tried the MAOIs, so understand I do not speak from experience. But I had some points I wanted to throw into the discussion.
First, I think all too often the medical world assumes antidepressants treat depression. While this is often true of course, it fails to recognize that any of several chemical imbalances can cause the exact same symptoms in mood, and only a few of them are addressed by antidepressants. And in a significant number of patients, it is actually a drug from a different class that normalizes the chemical imbalance--not an antidepressant. I believe that when 3 or 4 antidpressants have yielded substandard results, the priority has shifted to immediately trying other classes of drugs instead. For example the stimulants, stabilizers, antipsychotics, benzos. Within one of those groups will be found a best-fit. The best-fit drug will make itself known very quickly once it is tried. And it often ends up being one of the stimulants, as they correct a wide variety of organic problems in the brain.
It's just my opinion, but I believe exploring other classes of drugs makes sense before trying an MOAI. Especially since they can be done relatively quickly compared to the time it takes an antidepressant to work (if it ever works). Medication reactions with you so far point to the clues that your symptoms are caused by something beyond serotonin/NE deficiency. But whether you try an MAOI first or not, you are far from 'MAOI or bust'. There are drugs that target other chemical imbalances that, with you, have so far been overlooked. Any of those other chemical imbalances can cause your symptoms. Treatment for you so far has only focused on serotonin/NE low, without considering dopamine low, dopamine elevated (antipsychotics), chemical instability (lithium), electrical instability (depakote, tegretal), NE/dopamine failure (stimulants), low blood flow in parts of the brain (stimulants), poorly functioning patches of the brain (stimulants), or GABA low (benzos).
This is an overly simplistic way to look at it, but I just wanted to make the point that when multiple antidepressants disappoint, that is a pretty obvious clue to me that there is something else going on that will respond to a different class of drugs.
Posted by jd on February 19, 2000, at 22:02:46
In reply to Re: maoi or bust, posted by JohnL on February 19, 2000, at 4:09:56
Ryan,
Just a note to say that I totally agree with JohnL's post above. If you haven't yet tried a med that targets dopamine, it might be worth trying wellbutrin or selegiline before heading for the full-scale MAOIs, but there's still a good possibility that the real answer doesn't lie with conventional antidepressants at all. Once again, a truly experienced pdoc will be able to assess your situation and med history and come up with a more-or-less ordered list of medications worth trying: this list may include MAOIs or other antidepressants you haven't yet tried, but he/she may well want to try completely different meds, as these are often the most effective in people who haven't been responding to regular antidepressants. The odds are with you that something will help!
best,
jd
> Ryan,
>
> I have not tried the MAOIs, so understand I do not speak from experience. But I had some points I wanted to throw into the discussion.
>
> First, I think all too often the medical world assumes antidepressants treat depression. While this is often true of course, it fails to recognize that any of several chemical imbalances can cause the exact same symptoms in mood, and only a few of them are addressed by antidepressants. And in a significant number of patients, it is actually a drug from a different class that normalizes the chemical imbalance--not an antidepressant. I believe that when 3 or 4 antidpressants have yielded substandard results, the priority has shifted to immediately trying other classes of drugs instead. For example the stimulants, stabilizers, antipsychotics, benzos. Within one of those groups will be found a best-fit. The best-fit drug will make itself known very quickly once it is tried. And it often ends up being one of the stimulants, as they correct a wide variety of organic problems in the brain.
>
> It's just my opinion, but I believe exploring other classes of drugs makes sense before trying an MOAI. Especially since they can be done relatively quickly compared to the time it takes an antidepressant to work (if it ever works). Medication reactions with you so far point to the clues that your symptoms are caused by something beyond serotonin/NE deficiency. But whether you try an MAOI first or not, you are far from 'MAOI or bust'. There are drugs that target other chemical imbalances that, with you, have so far been overlooked. Any of those other chemical imbalances can cause your symptoms. Treatment for you so far has only focused on serotonin/NE low, without considering dopamine low, dopamine elevated (antipsychotics), chemical instability (lithium), electrical instability (depakote, tegretal), NE/dopamine failure (stimulants), low blood flow in parts of the brain (stimulants), poorly functioning patches of the brain (stimulants), or GABA low (benzos).
>
> This is an overly simplistic way to look at it, but I just wanted to make the point that when multiple antidepressants disappoint, that is a pretty obvious clue to me that there is something else going on that will respond to a different class of drugs.
This is the end of the thread.
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