![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by Margi on June 25, 2000, at 11:43:49
I have tried the following drugs over the last
13 years and they have been ineffective.
Wellbutrin Serzone Desiprimine Zoloft Paxil Buspar
Clonazapam Valium Mao Inhibitor (Parnate) I am presently on Valium and Parnate. The Valium
on Valium, which works, and Parnate. Yesterday I had a
food reaction with the parnate and it was very frightening. Is it worth the stroke risk to
ing , is it worth the stroke risk to take it. I've only
y been on the parnate for 2 weeks. The valium really
reduces my shaking and knotted up stomach so I can eat.
The thought of eating the wrong thing causes anxiety.
One part of me says stay on the Parnate long enough to see if it helps
see if it helps,
and if it does maybe the special diet is worth it.
But making a mistake and being rushed to the er is scary.
ey. I have diet ques. I did go to a dietician but she
had no MAo experience. Can I eat foods made with soy
flour or oils. When I open margarine, salad dressings
mayo, miracle whip, do I have to through them away in 2 dy
days. Along with ketchup mustard etc.
How long can one stay on Parnate? Is there a newer
drug I can try. the Doctor says I've tried every class.
Next is electro shock which I am not willing to do.
I am looking for a new psychiatrist because this one
does not return phone calls. I also have blindly
made an appt. with a new therapist, a female
this time. Please any suggestions or comments.
Thank you
Posted by Cam W. on June 25, 2000, at 12:32:55
In reply to MAOI Diet Restrictions, posted by Margi on June 25, 2000, at 11:43:49
Margi - A really good reference for MAOI diet is on this website. Scroll to the top of the page and and click on "Tips". Then scroll on the left hand side of the page to "MAOI Diet". This contains a fairly comprehensive list of "don'ts" and "maybes". Anything that is not covered, our MAOI experts will have an answer.
As for your pdoc not calling back...Welcome to psychiatry!
Hope this helps - Cam
Posted by Margi on June 25, 2000, at 19:05:37
In reply to Re: MAOI Diet Restrictions, posted by Cam W. on June 25, 2000, at 12:32:55
> Margi - A really good reference for MAOI diet is on this website. Scroll to the top of the page and and click on "Tips". Then scroll on the left hand side of the page to "MAOI Diet". This contains a fairly comprehensive list of "don'ts" and "maybes". Anything that is not covered, our MAOI experts will have an answer.
>
> As for your pdoc not calling back...Welcome to psychiatry!
>
> Hope this helps - Cam
Cam, Thanks for answering. I've read everything on this sight, been to a dietician and a pharmacist. I'm dealing with fear and anxiety over this.
The doc finally called back after my message said
I needed to come in. Tsalk to him tomorrow morning. I need to be
patience one step at a time. I've spent two days
trying to organize my thoughts and history. I'm getting a new doc
and therapist.
Posted by Adam on June 27, 2000, at 0:04:41
In reply to Re: MAOI Diet Restrictions, posted by Margi on June 25, 2000, at 19:07:06
Hey, Margi,It's natural to be afraid about the MAOI diet. I think most people who take an
MAOI and respond well to it find the dietary restrictions well worth the benefits
of the drug. From my own personal experience, I have found that many of the
"forbidden-foods" lists err on the side of caution, and that few things that are
not found on such lists should concern you. The numbers of MAOI users in this
country goes well into the hundreds of thousands, if not more. Each year only
a few hundred serious adverse events associated with MAOIs are reported, and that
includes all the deliberate and accidental overdoses, and the drug interactions.
There are only a handful of fatalities due to such interactions reported each
year, and I imagine only a fraction of those are due to unintentional exposures
to tyramine-rich foods.A good discussion of these issues can be found here:
http://emedicine.com/cgi-bin/foxweb.exe/showsection@d:/em/ga?book=emerg&topicid=318
It's also got a good "forbidden foods list".
I think the main thing you should worry about (not that you shouldn't be careful
with the foods, but there's no need to overdo it) are the drug interactions. Get
a Medic-Alert bracelet, and if you have any doubts about a drug, contact a doctor
or a pharmacist before taking it.
> > Margi - A really good reference for MAOI diet is on this website. Scroll to the top of the page and and click on "Tips". Then scroll on the left hand side of the page to "MAOI Diet". This contains a fairly comprehensive list of "don'ts" and "maybes". Anything that is not covered, our MAOI experts will have an answer.
> >
> > As for your pdoc not calling back...Welcome to psychiatry!
> >
> > Hope this helps - Cam
> Cam, Thanks for answering. I've read everything on this sight, been to a dietician and a pharmacist. I'm dealing with fear and anxiety over this.
> The doc finally called back after my message said
> I needed to come in. Tsalk to him tomorrow morning. I need to be
> patience one step at a time. I've spent two days
> trying to organize my thoughts and history. I'm getting a new doc
> and therapist.
Posted by Margi on June 27, 2000, at 2:24:28
In reply to Re: MAOI Diet Restrictions, posted by Adam on June 27, 2000, at 0:04:41
>Adam
Thank you for your encouragement. I am going to
read the emedicine sight. I am wearing a bracelat.
What do you do about keeping condiments,salsd dressings and miracle
whip inthe frig,how long. I made progress in the
grocery store today,I'm beginning to see the things I can eat instead
of the things I can't. I pray this drug helps
I'm stillnot sleeping but I surprisingly awake during the day. It's been almost
3 weeks.
> Hey, Margi,
>
> It's natural to be afraid about the MAOI diet. I think most people who take an
> MAOI and respond well to it find the dietary restrictions well worth the benefits
> of the drug. From my own personal experience, I have found that many of the
> "forbidden-foods" lists err on the side of caution, and that few things that are
> not found on such lists should concern you. The numbers of MAOI users in this
> country goes well into the hundreds of thousands, if not more. Each year only
> a few hundred serious adverse events associated with MAOIs are reported, and that
> includes all the deliberate and accidental overdoses, and the drug interactions.
> There are only a handful of fatalities due to such interactions reported each
> year, and I imagine only a fraction of those are due to unintentional exposures
> to tyramine-rich foods.
>
> A good discussion of these issues can be found here:
>
> http://emedicine.com/cgi-bin/foxweb.exe/showsection@d:/em/ga?book=emerg&topicid=318
>
> It's also got a good "forbidden foods list".
>
> I think the main thing you should worry about (not that you shouldn't be careful
> with the foods, but there's no need to overdo it) are the drug interactions. Get
> a Medic-Alert bracelet, and if you have any doubts about a drug, contact a doctor
> or a pharmacist before taking it.
> > > Margi - A really good reference for MAOI diet is on this website. Scroll to the top of the page and and click on "Tips". Then scroll on the left hand side of the page to "MAOI Diet". This contains a fairly comprehensive list of "don'ts" and "maybes". Anything that is not covered, our MAOI experts will have an answer.
> > >
> > > As for your pdoc not calling back...Welcome to psychiatry!
> > >
> > > Hope this helps - Cam
> > Cam, Thanks for answering. I've read everything on this sight, been to a dietician and a pharmacist. I'm dealing with fear and anxiety over this.
> > The doc finally called back after my message said
> > I needed to come in. Tsalk to him tomorrow morning. I need to be
> > patience one step at a time. I've spent two days
> > trying to organize my thoughts and history. I'm getting a new doc
> > and therapist.
Posted by janeS on June 27, 2000, at 12:42:22
In reply to Re: MAOI Diet Restrictions, posted by Margi on June 27, 2000, at 2:24:28
> >Adam
> Thank you for your encouragement. I am going to
> read the emedicine sight. I am wearing a bracelat.
> What do you do about keeping condiments,salsd dressings and miracle
> whip inthe frig,how long. I made progress in the
> grocery store today,I'm beginning to see the things I can eat instead
> of the things I can't. I pray this drug helps
> I'm stillnot sleeping but I surprisingly awake during the day. It's been almost
> 3 weeks.
> > Hey, Margi,
> >
> > It's natural to be afraid about the MAOI diet. I think most people who take an
> > MAOI and respond well to it find the dietary restrictions well worth the benefits
> > of the drug. From my own personal experience, I have found that many of the
> > "forbidden-foods" lists err on the side of caution, and that few things that are
> > not found on such lists should concern you. The numbers of MAOI users in this
> > country goes well into the hundreds of thousands, if not more. Each year only
> > a few hundred serious adverse events associated with MAOIs are reported, and that
> > includes all the deliberate and accidental overdoses, and the drug interactions.
> > There are only a handful of fatalities due to such interactions reported each
> > year, and I imagine only a fraction of those are due to unintentional exposures
> > to tyramine-rich foods.
> >
> > A good discussion of these issues can be found here:
> >
> > http://emedicine.com/cgi-bin/foxweb.exe/showsection@d:/em/ga?book=emerg&topicid=318
> >
> > It's also got a good "forbidden foods list".
> >
> > I think the main thing you should worry about (not that you shouldn't be careful
> > with the foods, but there's no need to overdo it) are the drug interactions. Get
> > a Medic-Alert bracelet, and if you have any doubts about a drug, contact a doctor
> > or a pharmacist before taking it.
> > > > Margi - A really good reference for MAOI diet is on this website. Scroll to the top of the page and and click on "Tips". Then scroll on the left hand side of the page to "MAOI Diet". This contains a fairly comprehensive list of "don'ts" and "maybes". Anything that is not covered, our MAOI experts will have an answer.
> > > >
> > > > As for your pdoc not calling back...Welcome to psychiatry!
> > > >
> > > > Hope this helps - Cam
> > > Cam, Thanks for answering. I've read everything on this sight, been to a dietician and a pharmacist. I'm dealing with fear and anxiety over this.
> > > The doc finally called back after my message said
> > > I needed to come in. Tsalk to him tomorrow morning. I need to be
> > > patience one step at a time. I've spent two days
> > > trying to organize my thoughts and history. I'm getting a new doc
> > > and therapist.
Margi:When I was first told I should take an MAOI I could not deal with the anxiety either...and anxiety was/is one of my big problems. It took me a few months to get used to the idea but then I did have a lot of confidence in my p-doc...so I finally did it. He told me basically to remember that if it 'bleeds or grows out of the ground' I could eat it. Well, after memorizing the MAOI diet list, I found it was much easier than I would have thought...though I did have to give up some of my favorite foods...some pizza, pickles, pepperoni, etc.
This was probably more relevant to you yesterday but I could not get it to post. You're right...when you go to the supermarket you realize how very little you have to give up. When cooking I did not use MSG but I did not hesitate to order in Chinese...so some of the warning may be similar to the results of the studies in mice...you know...are we EVER going to consume that amount?!
I was on Nardil for about 4 years and I felt so much better, because it has a a good anti-anxiety agent, (and I took it with 1mg Xanax/day) it was worth the extra effort to remember/question my special diet...and if you really want to get healthy, staying off these kinds of foods is better for you anyway.
The downside here, for me, was that it pooped-out on me after about 4 years...and now I am in that trial and error mode again...but I wish you lots of luck!
Jane
Posted by SLS on June 28, 2000, at 7:06:55
In reply to Re: MAOI Diet Restrictions, posted by janeS on June 27, 2000, at 12:42:22
> The downside here, for me, was that it pooped-out on me after about 4 years...and now I am in that trial and error mode again...but I wish you lots of luck!
>
> Jane
Hi Jane.Have you tried Marplan?
If you are not having success with your new drug trials, you may want to consider going back to Nardil. With Nardil, there are some cases in which taking a holiday from it and returning to it later helps to recapture the response.
Good luck.
- Scott
Posted by janeS on June 28, 2000, at 12:36:26
In reply to Re: MAOI Diet Restrictions » janeS, posted by SLS on June 28, 2000, at 7:06:55
> > The downside here, for me, was that it pooped-out on me after about 4 years...and now I am in that trial and error mode again...but I wish you lots of luck!
> >
> > Jane
>
>
> Hi Jane.
>
> Have you tried Marplan?
>
> If you are not having success with your new drug trials, you may want to consider going back to Nardil. With Nardil, there are some cases in which taking a holiday from it and returning to it later helps to recapture the response.
>
> Good luck.
>
>
> - ScottScott:
Thank you!...but is Marplan a MAOI?...Also, I have mentioned to my p-doc (not the one who originally prescribed Nardil) about going back to that as it has been almost 2 years and she says it has too many side effects...so I mentioned my first success story, Tofranil, and she says the same about it. It is obvious SSRI's DO NOT work.Additionally, I have been on Remeron (again) now for almost 3 weeks, and, after immediate response and relief, I am noticing that 'slide' starting again. Therefore I have been reading posts on Wellbutrin SR and combining that with the Remeron.
Any further insight on this would be so helpful...and I really appreciate your time.
Sincerely,
Jane
Posted by SLS on June 28, 2000, at 17:36:45
In reply to Re: MAOI Diet Restrictions, posted by janeS on June 28, 2000, at 12:36:26
Hi Jane.
Marplan (isocarboxezid) is an MAO inhibitor that is more similar to Nardil than it is to Parnate. I have seen people respond very well to Marplan that had not responded at all to Nardil.
What side effects in particular is your doctor concerned about?
What was your experience with Tofranil? Why did you discontinue it?
I guess it makes sense to select first those antidepressants that produce the least side effects. However, if one has already tried these without success, it makes sense to then try other drugs despite their liability to produce acceptable side effects. Now, if these drugs don't work, I think it makes a great deal of sense to try those drugs that already have. This seems logical to me.
Perhaps your doctor is not comfortable with using MAOIs and tricyclics because he has little experience with them. Tofranil (imipramine) is still the gold-standard by which all other antidepressants are compared for efficacy. You are already familiar with how this drug affects you, so I don't understand why a doctor would tell you that the side effects of Tofranil are unacceptable if you have expressed a desire to return to it. Desipramine (Norpramin) is also a tricyclic. In fact, it is the compound that Tofranil turns into when the body begins to break it down. Although desipramine can produce the same kinds of side effects as Tofranil, they are milder. The major concern with using tricyclics is that they can affect the heart. This is usually not a problem, but if your doctor is uncomfortable using these drugs, having an EKG would not be a bad idea.
I think it makes sense to explore a few drug combination strategies since you are not planning to go back to Nardil right away. One paper I read emphasized the effectiveness of combining Remeron with Effexor. Effexor plus Wellbutrin is another combination that I know can be effective when neither by itself is adequate. I think combining drugs that have already shown themselves to be partially effective is a good strategy. If Remeron helps, you may want to build combinations around it.
If you need to get radical, yet remain safe, you can combine an MAO inhibitor with a tricyclic. I mention this because you have had success with both. I have taken Nardil and desipramine together, but responded only minimally. When combined, I experienced more postural hypotension (low blood pressure upon standing) and had trouble initiating urination. There is some thought that the tricyclic can actually provide a buffer against a tyramine (cheese) reaction. The only drug regimen that ever worked for me was a combination of Parnate and desipramine. Unfortunately, my doctor at the time had me discontinue this treatment in favor of Prozac, which had just been approved. It didn't work. When it finally came time to try the combination again, I failed to respond to it. Here I am.
Good luck. Please post.
* Does anyone know if Remeron can be combined with an MAO inhibitor safely?
- Scott
Posted by janeS on June 28, 2000, at 18:28:47
In reply to Re: MAOI Diet Restrictions, posted by SLS on June 28, 2000, at 17:36:45
> Hi Jane.
>
>
> What side effects in particular is your doctor concerned about?
>
> What was your experience with Tofranil? Why did you discontinue it?
>
>One paper I read emphasized the effectiveness of combining Remeron with Effexor. Effexor plus Wellbutrin is another combination that I know can be effective when neither by itself is adequate. I think combining drugs that have already shown themselves to be partially effective is a good strategy. If Remeron helps, you may want to build combinations around it.
>
> If you need to get radical, yet remain safe, you can combine an MAO inhibitor with a tricyclic. I mention this because you have had success with both. I have taken Nardil and desipramine together, but responded only minimally. When combined, I experienced more postural hypotension (low blood pressure upon standing) and had trouble initiating urination. There is some thought that the tricyclic can actually provide a buffer against a tyramine (cheese) reaction. The only drug regimen that ever worked for me was a combination of Parnate and desipramine. Unfortunately, my doctor at the time had me discontinue this treatment in favor of Prozac, which had just been approved. It didn't work. When it finally came time to try the combination again, I failed to respond to it. Here I am.
>
> Good luck. Please post.
>
>
> * Does anyone know if Remeron can be combined with an MAO inhibitor safely?
>
>
> - ScottScott:
Your info and insight is incredible! Thank you soooo much!!! The p-doc I see now is the first of two p-doc's in my story. First time I ever went to see a p-doc she prescribed Tofranil (10 years ago). I remained on that except for 1 pregnancy for 4 years. Long story short, had a car accident, many doctors, many meds...then the descent into a black pain-depression cycle...which led me to the 2nd p-doc who weaned me off EVERYTHING and eventually placed me on Nardil.
Longer story shorter, Nardil pooped out after 4 years, went BACK to the 1st p-doc (almost 2 years ago) who then began my current trial and error period with ALL SSRI's, Buspar, Effexor, Effexor + Serzone and then just Serzone.(Just wanting you to have the Complete history...)
Something you said points out something I don't do...I don't take things to the next step, meaning when I asked her about Nardil she responded with side effects...I didn't say, "Which ones/What are they?" I simply took her word for it. Same thing with Tofranil and she was the one who treated me originally with Tofranil. Hmmmm... I think you hit the nail on the head as far as her expertise with MAOI's. She most likely stays away from them. We, in about 6+ years altogether have never discussed them.
My next appt. is 2+ weeks away...and I'm thinking of asking about the Remeron/Wellbutrin SR combo. Also at that time I will quiz her about the MAOI/Tofranil thing again. I intend to also ask about the Marplan...that sounds appealing as well. I'm the type of 'anxious' person who really doesn't do change really well...so the combo is appealing, but with more info and more time, I may be able to take the leap in a few months. (That would give the combo test enough time.)
I'm so tired of not feeling well...I've seen daylight before and I know it's still there...in theory. I would also very much like to be the adult I am supposed to be and get on with my life. I was an HR Director whose company sold, corporate headquarters closed and I was offered a similar position in Austin, TX (I'm in Lexington, KY) but I didn't want to make the move...so the new company set me up to telecommute from home and I have done that since February...but that project has ended so I'm TRYING to look for a new job...but I feel like I need to get this under control first...and then find myself wondering if I would do better having a job...a reason to get up, dressed, exciting and rewarding work, etc. I guess I'm trying to fix the beast and it's all interelated. Any thoughts on THAT one???
So, what about you? Since your combo has not worked out well, what are you doing?
Scott, thanks so much for all of your help and if this is just more than you wanted to get into I understand...but as I said earlier, I admire your knowledge and insight.
Gratefully,
Jane
Posted by shellie on June 29, 2000, at 6:35:30
In reply to Re: MAOI Diet Restrictions...Scott.., posted by janeS on June 28, 2000, at 18:28:47
Jane, I have had the exact experience that Scott described. I started nardil in my early 20s, before any of the ssris had been on the market. It worked really well for me for a number of years, then started to lose effectiveness. So for several months I went through trials of ssris, all unsuccessful. When I went back on the Nardil, it really kicked in again and I had success with it for about another 5 years. Starting this past January, I have had major depression breaking through, so I am going the augmentation route. If nothing seems to work, I may retry going off Nardil, then going back on. The reason I haven't tried that again, is last time when off the Nardil altogether, I totally crashed and had to wait for the Nardil to build up again to be functional. shellie
Posted by janeS on June 29, 2000, at 13:55:53
In reply to Re: MAOI » janeS, posted by shellie on June 29, 2000, at 6:35:30
>
> Jane, I have had the exact experience that Scott described. I started nardil in my early 20s, before any of the ssris had been on the market. It worked really well for me for a number of years, then started to lose effectiveness. So for several months I went through trials of ssris, all unsuccessful. When I went back on the Nardil, it really kicked in again and I had success with it for about another 5 years. Starting this past January, I have had major depression breaking through, so I am going the augmentation route. If nothing seems to work, I may retry going off Nardil, then going back on. The reason I haven't tried that again, is last time when off the Nardil altogether, I totally crashed and had to wait for the Nardil to build up again to be functional. shellieShellie:
Thanks for your input. Can you tell me what kind of augmentation with Nardil you're doing this second time around?
Jane
Posted by shellie on June 29, 2000, at 23:06:16
In reply to Re: MAOI...Shellie, posted by janeS on June 29, 2000, at 13:55:53
> Thanks for your input. Can you tell me what kind of augmentation with Nardil you're doing this second time around?
>
> JaneHi Jane. I'm trying to augment nardil with provigil. This is my second try with provigil. The first time I started with two high a dose and got really nauseated. So I stopped and after I felt better started again--two days ago, much slower--so far no problems.
I'm going to give you all the information that I gathered since January, when I felt the nardil lost effectiveness, since some part of it may be helpful to you. I'll try to condense.
In Feb did a trial of sam-e with Nardil, with on the phone supervision with a physician affiliated with Columbia U. who wrote a book on sam-e. He gave sam-e a 70% change of working. Unfortunately, it was not good for me--it made me more depressed and very agitated. But if you look at the sam-e board at www.delphi.com a lot of people who had tried lots of prescription meds, had enormous success with it.
He also said if the sam-e didn't work, these would be his recommendations to try with nardil:
1. thyroid, add 25 mc of cytomel (t3) for 2 weeks; can try 37.5 also
***2. lamcital- (anti-seizure medication) have to go up very very slowlyÑover a 3 month period--
3. add very low lithium level (works 50% of time)Ñ
4. add traxedone (deserel)
5. add pindolol
6. add ridlinBecause my pdoc was unwilling to experiment, I also consulted with a pdoc at NIMH by phone (very helpful) and with my old pdoc, who was no longer accepting my insurance.
The first choice of all three was lamictal. In the last" MAOI doesn't work anymore" thread, I explained that lamictal worked for me really well, but I was gaining weight. A very small percent of people gain weight on lamictal. I was unlucky and unwilling to accept a weight gain since there were other things for me to try. But I think it is very significant that all three doctors I consulted with, picked that as their first choice.
I'm surprised I don't read anything about it on this board, because knowlege of its success is well known, at least in Washington D.C. (where I am) and New York City.
I then returned to my old pdoc and pay out of pocket. After lamictal, her second choice for me was naltrexone (revia)--I tried it for one day and felt too drugged and weird.
Because she thought ridlin (sp?) would overstimulate me, we decided next on provigil. She wants to look into adrafinil before I order it, since I would like to try that if the provigil is not successful. After reading about two very very small studies of provigil augmentation with a 100 percent success rate (N = 7 for one, I can't remember the other, also very small) I am feeling hopeful.
btw, I was already taking thyroid, t2 & t3, and had already been unsuccesful with lithium.
Sorry this is so long--I am apparently not a successful condenser--but I thought giving you all the information might be useful.
Shellie
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.