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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 20 of 20. This is the beginning of the thread.
Posted by Peter on February 20, 2003, at 3:26:05
Hi all:
Just saw my pdoc. Because the lamictal is failing to alleviate my social anxiety, avoidant behaviour, and apprehension, it looks like I might have to start up another trial of an antidepressant next week. Since I've tried practically every SSRI already, with only temporary benefits, we were discussing the possibility of my going on an MAOI like Nardil-which I know is the best for social phobia. But he thought it best for me to try either strattera or lexapro first, knowing my hypochondriacal tendencies (I'll be all paranoid about the possibility of a hypertensive crisis with an MAOI). I don't understand his reasoning for straterra, but he claims it's a great drug and the fact that it doesn't affect serotonin might be good for me and have less of a chance of inducing alcohol cravings and making me ultra-impulsive like the SSRI's did after using them a few months. But, straterra is marketed for ADD, although I know it's an NRI like Roboxetine (sp?), which was an effective AD when it was still on the market. The thing is, I'd really be taking the AD more for anxiety/social phobia than for depression; supposedly, the lamictal would help with my depression as my body gets used to the 100mg+ range.
Question: If, as my pdoc has said before, TCA's are known to not be effective for social anxiety, how on earth could he claim that Straterra would be effective for it? He claimed out of the blue that they're realizing that SP has more to do with NE and DA than serotonin, and both TCA's (most of them) and strattera deal with NE, not serotonin. So how could he say on the one hand that TCA's don't work for SP, while also saying that straterra does? I don't understand that.
Also, as far as SSRI's go, any good experiences with Lexapro alleviating social anxiety? As well or better than Zoloft per chance? And how is it better than celexa? Does the isomer change really limit the drug's side-effects?
thanks,
Peter
Posted by jumpy on February 20, 2003, at 11:54:47
In reply to Pdoc appt.-Maoi or Lexapro or Straterra, posted by Peter on February 20, 2003, at 3:26:05
> Hi all:
> Just saw my pdoc. Because the lamictal is failing to alleviate my social anxiety, avoidant behaviour, and apprehension, it looks like I might have to start up another trial of an antidepressant next week. Since I've tried practically every SSRI already, with only temporary benefits, we were discussing the possibility of my going on an MAOI like Nardil-which I know is the best for social phobia. But he thought it best for me to try either strattera or lexapro first, knowing my hypochondriacal tendencies (I'll be all paranoid about the possibility of a hypertensive crisis with an MAOI). I don't understand his reasoning for straterra, but he claims it's a great drug and the fact that it doesn't affect serotonin might be good for me and have less of a chance of inducing alcohol cravings and making me ultra-impulsive like the SSRI's did after using them a few months. But, straterra is marketed for ADD, although I know it's an NRI like Roboxetine (sp?), which was an effective AD when it was still on the market. The thing is, I'd really be taking the AD more for anxiety/social phobia than for depression; supposedly, the lamictal would help with my depression as my body gets used to the 100mg+ range.
> Question: If, as my pdoc has said before, TCA's are known to not be effective for social anxiety, how on earth could he claim that Straterra would be effective for it? He claimed out of the blue that they're realizing that SP has more to do with NE and DA than serotonin, and both TCA's (most of them) and strattera deal with NE, not serotonin. So how could he say on the one hand that TCA's don't work for SP, while also saying that straterra does? I don't understand that.
> Also, as far as SSRI's go, any good experiences with Lexapro alleviating social anxiety? As well or better than Zoloft per chance? And how is it better than celexa? Does the isomer change really limit the drug's side-effects?
> thanks,
> PeterDon't waste anymore time Peter. Start what is proven to help social anxiety ... nardil. Add in neurontin or klonopin if need be.
Jumpy
Posted by Peter on February 20, 2003, at 13:03:15
In reply to Get on nardil » Peter, posted by jumpy on February 20, 2003, at 11:54:47
Hey Jumpy:
Tell me about it. It seems like the last 15 years have been lives in fear. Always wasting time, beacuse my Pdoc always wants to give each med a 'sufficient trial,' and he insists that we need to push the lamictal, because he just loves the drug. He thinks if my overall mood is better from the lamictal, so will my social anxiety. But I told him that even when I'm feeling fine, and I so much as hear about a future social occasion, I get that pit in my stomach and immediately start freaking out even thinking about it. So it could hit me even when I'm in a 'good' mood. And then it jus results in deterioration of relationships and of my own daily functioning-I pass up jobs offered to me, I make promises to go places with my fiancee and break them at the last minute, etc.
I agree I shouldn't waste time, and I know Nardil is the best. But what about the hypertensice crisis risk, and the food and medication interactions? I'd be afraid of mistakenly eating something in a restaurant with tyramine in it! It seems crazy! Is it really worth it? Do the pros outweigh the cons? Is it that much better than SSRI's at treating social anxiety?
thanks,
Peter
Posted by Ritch on February 20, 2003, at 13:47:48
In reply to Pdoc appt.-Maoi or Lexapro or Straterra, posted by Peter on February 20, 2003, at 3:26:05
> Hi all:
> Just saw my pdoc. Because the lamictal is failing to alleviate my social anxiety, avoidant behaviour, and apprehension, it looks like I might have to start up another trial of an antidepressant next week. Since I've tried practically every SSRI already, with only temporary benefits, we were discussing the possibility of my going on an MAOI like Nardil-which I know is the best for social phobia. But he thought it best for me to try either strattera or lexapro first, knowing my hypochondriacal tendencies (I'll be all paranoid about the possibility of a hypertensive crisis with an MAOI). I don't understand his reasoning for straterra, but he claims it's a great drug and the fact that it doesn't affect serotonin might be good for me and have less of a chance of inducing alcohol cravings and making me ultra-impulsive like the SSRI's did after using them a few months. But, straterra is marketed for ADD, although I know it's an NRI like Roboxetine (sp?), which was an effective AD when it was still on the market. The thing is, I'd really be taking the AD more for anxiety/social phobia than for depression; supposedly, the lamictal would help with my depression as my body gets used to the 100mg+ range.
> Question: If, as my pdoc has said before, TCA's are known to not be effective for social anxiety, how on earth could he claim that Straterra would be effective for it? He claimed out of the blue that they're realizing that SP has more to do with NE and DA than serotonin, and both TCA's (most of them) and strattera deal with NE, not serotonin. So how could he say on the one hand that TCA's don't work for SP, while also saying that straterra does? I don't understand that.
> Also, as far as SSRI's go, any good experiences with Lexapro alleviating social anxiety? As well or better than Zoloft per chance? And how is it better than celexa? Does the isomer change really limit the drug's side-effects?
> thanks,
> Peter
He may be tinkering with the idea of getting you off Adderall onto Straterra for your ADHD, and then see if the switch gets your anxiety down (and keeps your cravings under control). If that works (or partially works) he might then consider adding the Nardil since it would probably be much safer to try adding Nardil to an NE reuptake inhibitor like Straterra than it would be to risk adding it to a moderately high dose of a stimulant.
Posted by Thomas123 on February 20, 2003, at 15:17:34
In reply to Re: Pdoc appt.-Maoi or Lexapro or Straterra » Peter, posted by Ritch on February 20, 2003, at 13:47:48
There is a pill one can carry around which will abort a hypertensive crisis due to Nardil and tyramine. However, I have forgotten the name of the pill.
I think the real danger with nardil is trying to enhance the effectiveness of Nardil. There are various ways one can attempt to do this. I thought Nardil was great then it conked out and I tried foolishly to boost the action of Nardil via various means and Nardil reacts with a lot of drugs. This was a big mistake as there were a lot of side-effects.
Basically Naridl is a stand alone AD. One avoids OTC medications as much as possible with Nardil. That said except for hypotension it is fairly safe and the risk of a hypertensive crisis is small and there is the pill one can carry around to abort a hypertensive crisis.
I think it is the best AD. Nardil is the only AD one can fall in love with.
Posted by ace on February 20, 2003, at 19:37:54
In reply to Re: Get on nardil » jumpy, posted by Peter on February 20, 2003, at 13:03:15
> Hey Jumpy:
> Tell me about it. It seems like the last 15 years have been lives in fear. Always wasting time, beacuse my Pdoc always wants to give each med a 'sufficient trial,' and he insists that we need to push the lamictal, because he just loves the drug. He thinks if my overall mood is better from the lamictal, so will my social anxiety. But I told him that even when I'm feeling fine, and I so much as hear about a future social occasion, I get that pit in my stomach and immediately start freaking out even thinking about it. So it could hit me even when I'm in a 'good' mood. And then it jus results in deterioration of relationships and of my own daily functioning-I pass up jobs offered to me, I make promises to go places with my fiancee and break them at the last minute, etc.
> I agree I shouldn't waste time, and I know Nardil is the best. But what about the hypertensice crisis risk, and the food and medication interactions? I'd be afraid of mistakenly eating something in a restaurant with tyramine in it! It seems crazy! Is it really worth it? Do the pros outweigh the cons? Is it that much better than SSRI's at treating social anxiety?
> thanks,
> PeterYeah..It is MUCH better. You WOULD probably have to be careful at resturaurants, I don't even bother with them. But the pros FAR outweigh the cons, and I mean FAR. You get use to the diet...doesn't really bother me.
Ace.
Nardil, 90mg.
Posted by Peter on February 21, 2003, at 0:12:28
In reply to Re: Pdoc appt.-Maoi or Lexapro or Straterra » Peter, posted by Ritch on February 20, 2003, at 13:47:48
> He may be tinkering with the idea of getting you off Adderall onto Straterra for your ADHD, and then see if the switch gets your anxiety down (and keeps your cravings under control). If that works (or partially works) he might then consider adding the Nardil since it would probably be much safer to try adding Nardil to an NE reuptake inhibitor like Straterra than it would be to risk adding it to a moderately high dose of a stimulant.
> That theory makes sense to me, but he actually told me specifically that there's no danger in taking Nardil with Adderall. He said the interaction between Nardil and cocaine can be fatal, but that there's no danger in taking Nardil with an amphetamine! I guess he knows what he's talking about, but it seems strange to me.
He also said that Strattera is chemically almost identical in structure to Prozac, except that it has a different action, as it doesn't affect serotonin like Prozac does. And he said Strattera does help social anxiety even though it's an NARI (like TCA's-which are are not effective for social anxiety!) Lot's of strange contradictions here, or at least it seems like it. But again, I guess he knows what he's talking about.
Peter
Posted by Ritch on February 21, 2003, at 10:05:45
In reply to Re: Pdoc appt.-Maoi or Lexapro or Straterra, posted by Peter on February 21, 2003, at 0:12:28
> > He may be tinkering with the idea of getting you off Adderall onto Straterra for your ADHD, and then see if the switch gets your anxiety down (and keeps your cravings under control). If that works (or partially works) he might then consider adding the Nardil since it would probably be much safer to try adding Nardil to an NE reuptake inhibitor like Straterra than it would be to risk adding it to a moderately high dose of a stimulant.
> > That theory makes sense to me, but he actually told me specifically that there's no danger in taking Nardil with Adderall. He said the interaction between Nardil and cocaine can be fatal, but that there's no danger in taking Nardil with an amphetamine! I guess he knows what he's talking about, but it seems strange to me.
> He also said that Strattera is chemically almost identical in structure to Prozac, except that it has a different action, as it doesn't affect serotonin like Prozac does. And he said Strattera does help social anxiety even though it's an NARI (like TCA's-which are are not effective for social anxiety!) Lot's of strange contradictions here, or at least it seems like it. But again, I guess he knows what he's talking about.
> Peter
>
Yes, it does seem a little odd. Maybe he is thinking along the lines of medicine instead of "mechanism". IOW, fluoxetine, reboxetine, and tomoxetine, are all close chemical cousins despite having differing mechanisms. Reboxetine has gotten this "reputation" (hearsay?) that it significantly improves "social functioning" (motivation?). Prozac helps "social functioning" in many. So perhaps that is his logic? I would like to try the stuff (Straterra) and see if it will work for my inattentive ADD probs. without making me uptight. I've come to the conclusion that my hyperactivity is the bipolar element (which adds to distractability), and the ADD element is inattentiveness/absent-mindedness. Desipramine worked wonders on the inattentiveness before, but made me too edgy. Maybe Straterra wouldn't? I've heard some irritability reports, but noone complaining of anxiety yet.The MAOI thing--the monograph warns of using sympathomimetic substances with it (cocaine-amphetamines), SSRI's,venlafaxine, meperidine, bupropion, even Buspar. I have heard someone post here that was taking Nardil or Parnate say their doctor had gave them a *small* dose of dexedrine to alleviate the postural hypotension she was having with the MAOI. I suspect you would have to be off the Adderall before you started the MAOI and then your doc would have to add it back in slowly to see how you responded.
Posted by Lawrence S. on February 22, 2003, at 23:10:40
In reply to Pdoc appt.-Maoi or Lexapro or Straterra, posted by Peter on February 20, 2003, at 3:26:05
It's the only antideppresant, antianxiety, social lubricant that there is. Try it for a few months. Stick to the diet restrictions. TCA's and ssri's are crap!
Posted by Peter on February 23, 2003, at 0:36:45
In reply to Re: Pdoc appt.-Maoi or Lexapro or Straterra » Peter, posted by Ritch on February 21, 2003, at 10:05:45
Yeah, it's a toss up between Nardil and straterra. On the one hand, the thought of straterra stresses me out a lot less, since it doesn't have such bizarre interactions with food and other meds. I've also seen some positive posts here on peoples' experiences with straterra-that it has good effects on the mood-depression and anxiety as well as ADD. There's also the possibility that I'm not experiencing the lamictal benefits because the adderall might be exacerbating my mood swings; perhaps, in this respect, straterra would be a much 'cleaner' alternative that could give me a clearer picture of whether the lamictal is in fact helping me.
On the other hand, if I'm going to take yet another med, I would like it to be something that has more of a concrete potential to help my symptoms in the long run. In other words, I absolutely do not want to continue going around in circles; I'm sure you can all relate.
Even though the SSRI's helped me for a few months at a time, they are certainly not long term solutions; it's fair to say I've had enough trials of SSRI's to make that conclusion.
The straterra, while it has it's 'clean' benefits, might just be another med that, like so many others, would help me for a short period and then require me to 'wash-out' and start from scratch again.
Now we get to the Nardil. I've heard it's like some wonder drug or something. But I'm still having trouble coming to grips with the dangers associated with it. I've already been going through a decent amount of stress regarding the possibility of the fatal lamictal rash. Now it will be the lamictal rash PLUS the "woops-I might have just eaten some tyramine by mistake-time to go to the ER." I've seen some posts that mention people having to go to the hospital even after taking that anti-hypertensive antidote med.
I'm sure my pdoc will keep me on lamictal if I start Nardil, so I'd end up with 2 meds that I'd classify as pretty 'serious' when it comes to possible fatal reactions. Not to mention that my pdoc seems pretty sure about certain things that seemingly contradict Nardil's safety profile (according to its monograph). For instance, he said it's fine to take a stimulant like adderall with Nardil, but he said cocaine and Nardil can be a lethal combo. The monograph, as Mitch pointed out to me, says both amphetamines and cocaine are listed under the contraindictions. Those little discrepencies between what my pdoc says and what the medical documents say further add to my stress about taking Nardil, though I do have an accompanying curiosity that it might very well be the one med that, if it doesn't kill me, might actually work where all the other meds failed! It's a double-edged sword, no doubt.
That's when I start trying to consider if I really need to start another med at all. Yes, I've been feeling especially sucky lately, but there are times when, if faced with an unexpected social occasion, I don't freak out and I seem fine. it has always been much easier for me to reach for a pill instead of considering possible psychological factors that lead me into these awful mood states. Trust me, I'm not talking as an anti-med, 'suck it up and deal with it' person-I've taken my fair share of meds, and if anything, I'm a big-time med advocate!
But I have to consider-am I 'ill' enough to take Nardil, or am I just never satisfied with my life because of other reasons that relate more to psychological and spiritual health than to a stubborn biological imbalance? I guess this is a big topic for many.
As you can see, I'm still in the dark about this, but I thank you all for your feedback. Any further opinions? My doc said if I'm not out of this funk by Monday or Tuesday, I should consider the MAOI or straterra-so the choice seems like it's up to me and I'm still torn between either or neither.
Thanks,
Peter
Posted by Ritch on February 23, 2003, at 9:39:37
In reply to New Thoughts, posted by Peter on February 23, 2003, at 0:36:45
> Yeah, it's a toss up between Nardil and straterra. On the one hand, the thought of straterra stresses me out a lot less, since it doesn't have such bizarre interactions with food and other meds. I've also seen some positive posts here on peoples' experiences with straterra-that it has good effects on the mood-depression and anxiety as well as ADD. There's also the possibility that I'm not experiencing the lamictal benefits because the adderall might be exacerbating my mood swings; perhaps, in this respect, straterra would be a much 'cleaner' alternative that could give me a clearer picture of whether the lamictal is in fact helping me.
> On the other hand, if I'm going to take yet another med, I would like it to be something that has more of a concrete potential to help my symptoms in the long run. In other words, I absolutely do not want to continue going around in circles; I'm sure you can all relate.
> Even though the SSRI's helped me for a few months at a time, they are certainly not long term solutions; it's fair to say I've had enough trials of SSRI's to make that conclusion.
> The straterra, while it has it's 'clean' benefits, might just be another med that, like so many others, would help me for a short period and then require me to 'wash-out' and start from scratch again.
> Now we get to the Nardil. I've heard it's like some wonder drug or something. But I'm still having trouble coming to grips with the dangers associated with it. I've already been going through a decent amount of stress regarding the possibility of the fatal lamictal rash. Now it will be the lamictal rash PLUS the "woops-I might have just eaten some tyramine by mistake-time to go to the ER." I've seen some posts that mention people having to go to the hospital even after taking that anti-hypertensive antidote med.
> I'm sure my pdoc will keep me on lamictal if I start Nardil, so I'd end up with 2 meds that I'd classify as pretty 'serious' when it comes to possible fatal reactions. Not to mention that my pdoc seems pretty sure about certain things that seemingly contradict Nardil's safety profile (according to its monograph). For instance, he said it's fine to take a stimulant like adderall with Nardil, but he said cocaine and Nardil can be a lethal combo. The monograph, as Mitch pointed out to me, says both amphetamines and cocaine are listed under the contraindictions. Those little discrepencies between what my pdoc says and what the medical documents say further add to my stress about taking Nardil, though I do have an accompanying curiosity that it might very well be the one med that, if it doesn't kill me, might actually work where all the other meds failed! It's a double-edged sword, no doubt.
> That's when I start trying to consider if I really need to start another med at all. Yes, I've been feeling especially sucky lately, but there are times when, if faced with an unexpected social occasion, I don't freak out and I seem fine. it has always been much easier for me to reach for a pill instead of considering possible psychological factors that lead me into these awful mood states. Trust me, I'm not talking as an anti-med, 'suck it up and deal with it' person-I've taken my fair share of meds, and if anything, I'm a big-time med advocate!
> But I have to consider-am I 'ill' enough to take Nardil, or am I just never satisfied with my life because of other reasons that relate more to psychological and spiritual health than to a stubborn biological imbalance? I guess this is a big topic for many.
> As you can see, I'm still in the dark about this, but I thank you all for your feedback. Any further opinions? My doc said if I'm not out of this funk by Monday or Tuesday, I should consider the MAOI or straterra-so the choice seems like it's up to me and I'm still torn between either or neither.
> Thanks,
> Peter
I'd go for the Straterra for now because you can continue to take Adderall while you are on it. That way you are just adding on something else-and you won't be going through a possible withdrawal (Adderall), at the same time you start the Nardil. There will be less confusion as to what is causing what (adverse effects from the Nardil or Adderall discontinuation syndrome?). I would be just as concerned about taking an MAOI with an amphetamine as you are. Give the Straterra 2-3 weeks and see if it helps any. If not-then drop it and hash-out a way to start the Nardil with your pdoc that doesn't leave you uptight and wondering about his judgement.
Posted by SLS on February 23, 2003, at 11:38:03
In reply to Re: New Thoughts » Peter, posted by Ritch on February 23, 2003, at 9:39:37
Hi.
There is no reason why an MAOI cannot be combined with any psychostimulant as long as prudence is exercised. It is probably a good idea to check for hypertension when first adding a stimulant to Parnate, especially after the first dose. Parnate is known to infrequently produce hypertensive episodes, even when used as monotherapy and in the absence of tyramine. Personally, I have tried Parnate 120mg + desipramine 300mg + (Ritalin or Dexedrine). It is my impression that Parnate is used most often in this type of combination. My guess is that the type of depression most often chosen to treat using this combination strategy is either anergic or bipolar. Parnate has traditionally been the MAOI of choice in these cases. However, it is likely that any irreversible MAOI would have the potential to be successful.
Psychostimulants
------------------------------------------------
methylphenidate (Ritalin, Concerta, Metadate)
dexmethylphenidate (Focalin)
d-amphetamine (Dexedrine)
amphetamine salts (Adderall)
pemoline (Cylert)
modafinil (Provigil)Documentation can be found within Dr. Bob's Tips:
http://www.dr-bob.org/tips/split/MAOIs-in-high-doses-and-wi.html
Also:http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=3997787&dopt=Abstract
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=2056139&dopt=Abstract
- Scott
Posted by Lawrence S. on February 24, 2003, at 0:06:49
In reply to New Thoughts, posted by Peter on February 23, 2003, at 0:36:45
Is anyone getting an antideppresant effect from strattera? I asked my pdoc if I could try it and his response was: "Strattera was originally developed for deppression but was found innefective in clinical trials. A later trial found it was effective for ADD." Does anyone have anything to contradict this? If so, I would like to show it to him and set him strait.
Posted by Peter on February 25, 2003, at 0:33:42
In reply to Re: New Thoughts » Peter, posted by Ritch on February 23, 2003, at 9:39:37
> I'd go for the Straterra for now because you can continue to take Adderall while you are on it. That way you are just adding on something else-and you won't be going through a possible withdrawal (Adderall), at the same time you start the Nardil. There will be less confusion as to what is causing what (adverse effects from the Nardil or Adderall discontinuation syndrome?). I would be just as concerned about taking an MAOI with an amphetamine as you are. Give the Straterra 2-3 weeks and see if it helps any. If not-then drop it and hash-out a way to start the Nardil with your pdoc that doesn't leave you uptight and wondering about his judgement.
> Very sensible as always Mitch-moreso than my pdoc(-:
I spoke with him tonight and he said that if I do start straterra and it doesn't work, I'd have to go through yet another multiple-week washing out period before I could even begin the MAOI. He also said straterra has as much a chance of agitating me at the beginning as any med with antidepressant qualities. He said that MAOI's are used commonly along with stims, as those posts that Scott put up show (BTW, thanks so much for those posts, Scott-they've been very helpful). So, basically, I'm going to try to get some sleep, since I really haven't been sleeping at all lately, and he's going to send me literature on MAOI dietary restrictions & we will take it from there. Still considering both. I'll keep you updated. Thanks everyone,
Peter
Posted by Ritch on February 25, 2003, at 9:04:29
In reply to Re: New Thoughts, posted by Peter on February 25, 2003, at 0:33:42
> I spoke with him tonight and he said that if I do start straterra and it doesn't work, I'd have to go through yet another multiple-week washing out period before I could even begin the MAOI. He also said straterra has as much a chance of agitating me at the beginning as any med with antidepressant qualities. He said that MAOI's are used commonly along with stims, as those posts that Scott put up show (BTW, thanks so much for those posts, Scott-they've been very helpful). So, basically, I'm going to try to get some sleep, since I really haven't been sleeping at all lately, and he's going to send me literature on MAOI dietary restrictions & we will take it from there. Still considering both. I'll keep you updated. Thanks everyone,
> Peter
>Peter, you mentioned a multiple week washout. Are there meds you would be continuing while you washout the others? I figured you would stay on your Lamictal at least. Or is it just the Adderall you would have to drop and then add it back once you are on the Nardil? Just curious how your pdoc was going to handle the washout (what meds get stopped when, started when, etc.).
Posted by Peter on February 25, 2003, at 10:51:45
In reply to Re: New Thoughts » Peter, posted by Ritch on February 25, 2003, at 9:04:29
> Peter, you mentioned a multiple week washout. Are there meds you would be continuing while you washout the others? I figured you would stay on your Lamictal at least. Or is it just the Adderall you would have to drop and then add it back once you are on the Nardil? Just curious how your pdoc was going to handle the washout (what meds get stopped when, started when, etc.).
>Hey Mitch:
The multiple-week washout was referring to if I started Straterra and it didn't work, I'd have to have it all washed out of my system for at least 2 weeks before starting up an MAOI. That's all I meant. I guess Straterra is counted as an antidepressant when it comes to not being able to have any of it in your system when beginning an MAOI. If I skip the straterra trial and go right to Nardil, pdoc said there's nothing I have to wash-out from now; I would stay on the lamictal and lower the adderall dose - only because it makes my heart-rate a little high so he would want to be cautious about that and lower it before I take the Nardil. I also asked him if there could be any difficulty discerning between an adverse reaction to Nardil and withdrawel feelings from adderall, and he said it would be easy to discern an adverse reaction to Nardil no matter what other meds you're lowering or increasing when you take it. Everything else-the klonopin, temazepam, ambien, and lamictal-I don't have to adjust before beginning the MAOI. But I do have to adhere to the diet beginning 2 days before I start the Nardil. I hope that answers your question-my ADD is really flaring up today. Have a good one,
Peter
Posted by Ritch on February 25, 2003, at 13:18:38
In reply to Re: New Thoughts » Ritch, posted by Peter on February 25, 2003, at 10:51:45
> > Peter, you mentioned a multiple week washout. Are there meds you would be continuing while you washout the others? I figured you would stay on your Lamictal at least. Or is it just the Adderall you would have to drop and then add it back once you are on the Nardil? Just curious how your pdoc was going to handle the washout (what meds get stopped when, started when, etc.).
> >Hey Mitch:
> The multiple-week washout was referring to if I started Straterra and it didn't work, I'd have to have it all washed out of my system for at least 2 weeks before starting up an MAOI. That's all I meant. I guess Straterra is counted as an antidepressant when it comes to not being able to have any of it in your system when beginning an MAOI. If I skip the straterra trial and go right to Nardil, pdoc said there's nothing I have to wash-out from now; I would stay on the lamictal and lower the adderall dose - only because it makes my heart-rate a little high so he would want to be cautious about that and lower it before I take the Nardil. I also asked him if there could be any difficulty discerning between an adverse reaction to Nardil and withdrawel feelings from adderall, and he said it would be easy to discern an adverse reaction to Nardil no matter what other meds you're lowering or increasing when you take it. Everything else-the klonopin, temazepam, ambien, and lamictal-I don't have to adjust before beginning the MAOI. But I do have to adhere to the diet beginning 2 days before I start the Nardil. I hope that answers your question-my ADD is really flaring up today. Have a good one,
> PeterHey, that clears things up a bunch. The Nardil idea sounds like a much better deal (and much less of a hassle) to me given that info. good luck!
Posted by Peter on March 1, 2003, at 0:30:28
In reply to Re: New Thoughts » Peter, posted by Ritch on February 25, 2003, at 13:18:38
> Hi Mitch:
I finally saw my doc today. I tried to adhere to the MAOI dietary restrictions for the last 2 days-just to get an idea of how I'd cope with them. I gotta say that, with my anxious/hypochondriacal temperament, it was very difficult. But I was still under the impression that Nardil was the direction we were going in. But as we got into the meeting, he decided that the MAOI wouldn't be a good choice for me now; as he put it: 'it's like I'd have to give you another drug to help you to take the Maoi.' He didn't say this harshly or anything-he and I are always joking around. I told him what I mentioned on a post here about that if I did start up on another med, I'd prefer it to be something most likely to help in the long-term (not just another med that will ultimately end up exacerbating instead of helping my mood trends, thus requiring further med trials). He said there's no guarantee that the Nardil would help anymore than anything else, so it's not quite worth my taking it, what with all the anxiety I have about it.
If you recall, my original other choice was Straterra; but he told me that he's been treating many patients with Straterra since it came out, and over the last week or two he's been getting a lot of complaints about it causing agitation/irritability. He also said that Straterra or a TCA would help my SP only to the extent that my SP is driven by my general mood; in other words, they do not directly treat social anxiety like MAOI's or SSRI's.
Believe it or not, he decided the best thing to do would be to keep me on the lamictal 100mg, using it as a mood-stabilizer, and start Prozac at very low doses. Firstly, he said I always took depakote with the other SSRI's and the replacement of the depakote with the lamictal with a SMALL dose of an SSRI-especially Prozac- might just be what I need to balance out the SP/periodic depression.
As for Prozac in particular, I've never tried it, and he said it has a good balance between energizing yet calming effects. And if it only works for a few months for me, its long half-life causes its cessation to not produce the level of withdrawal symptoms of an SSRI w/ a short half-life (like zoloft).
It seemed like a strange choice at first, especially after all he had said in the past about SSRI's NOT working well with me, but he was very convincing today in his reasons for my taking Prozac. What do you think?
BTW, have you taken Prozac? Also, out of curiosity, ever taken Nardil?
Hope all is well,
Peter
Posted by Ritch on March 1, 2003, at 9:50:03
In reply to Re: New Thoughts » Ritch, posted by Peter on March 1, 2003, at 0:30:28
> > Hi Mitch:
> I finally saw my doc today. I tried to adhere to the MAOI dietary restrictions for the last 2 days-just to get an idea of how I'd cope with them. I gotta say that, with my anxious/hypochondriacal temperament, it was very difficult. But I was still under the impression that Nardil was the direction we were going in. But as we got into the meeting, he decided that the MAOI wouldn't be a good choice for me now; as he put it: 'it's like I'd have to give you another drug to help you to take the Maoi.' He didn't say this harshly or anything-he and I are always joking around. I told him what I mentioned on a post here about that if I did start up on another med, I'd prefer it to be something most likely to help in the long-term (not just another med that will ultimately end up exacerbating instead of helping my mood trends, thus requiring further med trials). He said there's no guarantee that the Nardil would help anymore than anything else, so it's not quite worth my taking it, what with all the anxiety I have about it.
> If you recall, my original other choice was Straterra; but he told me that he's been treating many patients with Straterra since it came out, and over the last week or two he's been getting a lot of complaints about it causing agitation/irritability. He also said that Straterra or a TCA would help my SP only to the extent that my SP is driven by my general mood; in other words, they do not directly treat social anxiety like MAOI's or SSRI's.
> Believe it or not, he decided the best thing to do would be to keep me on the lamictal 100mg, using it as a mood-stabilizer, and start Prozac at very low doses. Firstly, he said I always took depakote with the other SSRI's and the replacement of the depakote with the lamictal with a SMALL dose of an SSRI-especially Prozac- might just be what I need to balance out the SP/periodic depression.
> As for Prozac in particular, I've never tried it, and he said it has a good balance between energizing yet calming effects. And if it only works for a few months for me, its long half-life causes its cessation to not produce the level of withdrawal symptoms of an SSRI w/ a short half-life (like zoloft).
> It seemed like a strange choice at first, especially after all he had said in the past about SSRI's NOT working well with me, but he was very convincing today in his reasons for my taking Prozac. What do you think?
> BTW, have you taken Prozac? Also, out of curiosity, ever taken Nardil?
> Hope all is well,
> Peter
Hi Peter, Never taken an MAOI. My depressions never reach the severe level. At their worst it gets tough to make it to work (a few days per major episode) and my cognitive function is primarily impaired and I make mistakes and I am very TIRED, HUNGRY, and I gain weight and sleep a lot. I've got two different "times" of depression-the seasonal thing I just mentioned (bi-annual) and short-term chronic(few days) depressions that occur during my three week mood cycle that churns away nonstop through the year.Your doctor may think you are becoming more stable on the Lamictal (you sound more stable now than ever BTW) and doesn't want to "rock the boat" big time with an MAOI. You said you would have to reduce your Adderall (creating one potential problem), become vigilant with your diet (creating more anxiety), and needing to carry around or take a high blood pressure med to enable you to maintain the Adderall (more polypharmacy). I don't think he fully realized the impact of the change. OTOH, he possibly was wanting to reassure you that he would be willing to try it (MAOI) and wanted you to go over all of the ramifications of taking it well before a decision was made (your literature on food restrictions, etc.) to gauge your full reaction to the idea.
I think your doctor is correct about TCA/Straterra helping your SP sx only to the "extent that it was driven by your mood". My SP symptoms are VERY driven by what mood state I happen to be in. I withdraw socially when I get depressed and experience more anxiety generally. When I get hypomanic I'm the one with the lampshade on, and going up to strangers and asking their name and shaking their hands, and BS'ing with them. Meds that get me up and MOVING are the ones that help the best when I am depressed.
Prozac was my favorite SSRI as far as what it did for my *head*. I have IBS problems and all SSRI's and lithium just wreak havoc on the poor nerves in my gut. I also had improved attention on Prozac. It was the only SSRI that helped with that (not even Effexor helps much in that dept., but easier on the tummy). Zoloft gets me off my ass and motivating, but it caused a lot of nausea and the worst sleep disturbances of any of them. The only AD's that consistently improved attention for me have been desipramine, Prozac, and Wellbutrin (not as well as the former two). And Prozac reduced anxiety whereas the other two tend to make it worse. I still want to try a *little* Straterra with my Effexor, though. You may get a similar effect with the Prozac. It sounds like a good pick!----good luck, Mitch
Posted by Peter on March 1, 2003, at 12:10:08
In reply to Re: New Thoughts » Peter, posted by Ritch on March 1, 2003, at 9:50:03
This is the end of the thread.
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