Psycho-Babble Medication Thread 363868

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King Vultan-MAOI Diet?

Posted by bluebird on July 7, 2004, at 21:55:15

Hello, just curious how difficult the MAOI diet is. I mean how can you be sure of the freshness of veggies, meats, and so forth. Have you had a difficult time on this diet. I have been reading a lot about it and the opinions vary. Your input would be appreciated. Thanks, bluebird

 

Re: King Vultan-MAOI Diet? bluebird

Posted by King Vultan on July 8, 2004, at 9:39:47

In reply to King Vultan-MAOI Diet?, posted by bluebird on July 7, 2004, at 21:55:15

> Hello, just curious how difficult the MAOI diet is. I mean how can you be sure of the freshness of veggies, meats, and so forth. Have you had a difficult time on this diet. I have been reading a lot about it and the opinions vary. Your input would be appreciated. Thanks, bluebird


The dietary restrictions are what scare many people off, but in practice, I have not found them to be much of a hardship. If you've looked at Perry and Lund's paper Monoamine Oxidase Inhibitors: Adverse Effects, there really are not a huge number of items that are absolutely restricted. For me, the key ones are the aged cheeses and the aged and cured meats. I've been avoiding anything with cheddar cheese, which is the only "aged" cheese I consume, and I've had to modify my lunch sandwiches and pizza selections to abide with the restrictions. I used to get summer sausage, salami, etc. for sandwiches but have been pretty much sticking with peanut butter since going on Nardil (ordinary bologna would also be okay. Likewise, ordinary hot dogs--nonsmoked, non-esoteric--are also okay).

Pizza can be a problem, especially pepperoni, and especially on Parnate because that is the more dangerous of the two MAOIs as far as generating hypertensive crises. I've read at least two anecdotes by different people on Parnate who suffered hypertensive crises after eating pepperoni pizza. However, studies done up at Sunnybrook, Toronto by Dr. Shulman, et al, showed nearly zero tyramine in Pizza Hut and Domino's double cheese double pepperoni pizzas. I do believe the two people who suffered hypertensive crises on Parnate did eat at smaller, unaffiliated local pizza places, with perhaps more aged/authentic pepperoni. I get pizzas myself from the Papa Murphy's take them home and cook them chain, and I do not select their pepperoni, because my impression is that it is higher quality and possibly more aged than what you might find on a Domino's pizza. I also specify mozzarella only, as Papa Murphy's normally use a three cheese blend.

From the standpoint of freshness, I would try to avoid foods like liver, which can become very problematic for MAOI users because it's been shown that it generates very high tyramine levels in a fairly short time as it ages. The concern with freshness is aged and spoiled protein, so vegetables would not be expected to be much of a problem (other than something like sauerkraut, which is absolutely forbidden, anyway). I carry two 10 mg nifedipine pills with me, more as a psychological security blanket than anything else because I really do not expect to use them, as I am relatively careful and cautious and am on Nardil, anyway. However, there is always the chance I could eat some truly rotten meat or something that had some soy sauce in it unbeknownst to me and so develop a reaction. Now that I've been on Nardil for a few months, the dietary restrictions really don't seem like a big deal anymore. They are certainly way less restrictive than an Atkins diet.

Todd

 

Re: King Vultan-MAOI Diet?

Posted by Ilene on July 8, 2004, at 11:54:27

In reply to King Vultan-MAOI Diet?, posted by bluebird on July 7, 2004, at 21:55:15

The diet is not as restrictive as some of the literature indicates. I'm taking Marplan, and I stay away from aged cheese and some Asian foods. I miss the cheese. (Mexican restaurants can be a problem.) I've eaten a little pizza from chains such as Domino's. Most cheeseburgers are made with American cheese, which isn't really cheese.

I've been eating a lot of Asian food recently (just moved to San Francisco). I found I'm okay with Kikkoman soy sauce. I don't have miso soup anymore. I haven't tried anything with black bean sauce.

Overall, the dietary restrictions are no big deal.

Good luck,

I.

 

Re: King Vultan-MAOI Diet? Ilene

Posted by gardenergirl on July 8, 2004, at 16:11:09

In reply to Re: King Vultan-MAOI Diet?, posted by Ilene on July 8, 2004, at 11:54:27

I've had black bean sauce from a jar and had no problem.

gg

 

Re: King Vultan-MAOI Diet? King Vultan

Posted by bluebird on July 9, 2004, at 11:34:50

In reply to Re: King Vultan-MAOI Diet? bluebird, posted by King Vultan on July 8, 2004, at 9:39:47

So, Nardil has less chance of the hpertensive crisis. Is that what I am understanding you to say. What about alcohol? Is it to never be consumed? See I have been trying to decide Parnate or Nardil. If Nardil has less chance of this then I may go with Nardil. But Parnate doesn't have as many sexual SE right? That's the difference. How do I get to the MAOI post that you were talking about? I am new to this and not very experienced at doing these post. Thanks for all of your info. bluebird

 

Re: King Vultan-MAOI Diet? King Vultan bluebird

Posted by King Vultan on July 9, 2004, at 12:14:36

In reply to Re: King Vultan-MAOI Diet? King Vultan, posted by bluebird on July 9, 2004, at 11:34:50

> So, Nardil has less chance of the hpertensive crisis. Is that what I am understanding you to say. What about alcohol? Is it to never be consumed? See I have been trying to decide Parnate or Nardil. If Nardil has less chance of this then I may go with Nardil. But Parnate doesn't have as many sexual SE right? That's the difference. How do I get to the MAOI post that you were talking about? I am new to this and not very experienced at doing these post. Thanks for all of your info. bluebird


Sorry, you said you had done a lot of reading, and I figured you had seen this:

http://www.vh.org/adult/provider/psychiatry/CPS/19.html

This article is one of the two best I have seen for information on MAOIs. You may want to take a look at table 3, which gives a subjective comparison of the adverse effects of all three MAOIs. Table 2 also has some info comparing Nardil and Parnate, but it is based on a fairly limited number of study subjects. However, the 22% occurrence of anorgasmia/impotence for the 141 people on Nardil (vs. 2% for the 41 people on Parnate) is a number that really jumps out at you.

The sources referenced in the article recommend "no more than two domestic bottled or canned beers or 4-fl-oz glasses of red or white wine per day, this includes nonalcoholic beer." They specifically state to avoid tap beer, as high tyramine concentrations have been found in several cases. The people up at Sunnybrook/Toronto even had one of their patients on Nardil suffer a hypertensive crisis after drinking tap beer at a local bar, as I recall; and my opinion is that tap beer is one of the most critical things to avoid while on an MAOI. As to the number of drinks per day, I will admit to on occasion, imbibing more than the two they recommend, but each person will have to make his or her own decision on that one.

Todd

 

Re: King Vultan-MAOI Diet? Correction bluebird

Posted by King Vultan on July 9, 2004, at 12:29:52

In reply to Re: King Vultan-MAOI Diet? King Vultan, posted by bluebird on July 9, 2004, at 11:34:50

I made a reference to Table 2 in my previous post; I should have said Table 1 for the comparison of Nardil and Parnate based on 141 Nardil test subjects and 41 for Parnate.

Table 2 is actually a comparison of Nardil vs the tricyclic amitriptyline, a drug generally regarded as having notoriously bad side effects. Nardil does wind up having fewer overall side effects on a statistical basis, but my opinion is that amitriptyline is likely more intolerable than what the data indicates. For instance, the statistics show both drugs reported as sedating by a similar percentage of test subjects, but I have to believe the actual effect on the subjects of the heavily sedating amitriptyline is noticeably more intense than that of the mildly/moderately sedating Nardil.

Todd

 

Re: King Vultan-MAOI Diet? King Vultan bluebird

Posted by Ilene on July 9, 2004, at 12:59:29

In reply to Re: King Vultan-MAOI Diet? King Vultan, posted by bluebird on July 9, 2004, at 11:34:50

I chose Marplan because it seemed to fall between Nardil and Parnate in terms of side effects. The only problem I had was dizziness because it lowered my blood pressure. That went away when I went from 50mg to 40mg.

Marplan is much more tolerable than many of the other ADs. I think the MAOIs are underprescribed. They went out of style when other ADs came on the market, and most pdocs by now don't have experience with them.

 

Re: King Vultan-MAOI Diet? King Vultan

Posted by KaraS on July 9, 2004, at 19:10:57

In reply to Re: King Vultan-MAOI Diet? King Vultan bluebird, posted by Ilene on July 9, 2004, at 12:59:29

> I chose Marplan because it seemed to fall between Nardil and Parnate in terms of side effects. The only problem I had was dizziness because it lowered my blood pressure. That went away when I went from 50mg to 40mg.
>
> Marplan is much more tolerable than many of the other ADs. I think the MAOIs are underprescribed. They went out of style when other ADs came on the market, and most pdocs by now don't have experience with them.


How has it worked for you in terms of fighting depression?

 

Re: King Vultan-MAOI Diet? King Vultan

Posted by Ilene on July 10, 2004, at 0:10:37

In reply to Re: King Vultan-MAOI Diet? King Vultan, posted by KaraS on July 9, 2004, at 19:10:57

> > I chose Marplan because it seemed to fall between Nardil and Parnate in terms of side effects. The only problem I had was dizziness because it lowered my blood pressure. That went away when I went from 50mg to 40mg.
> >
> > Marplan is much more tolerable than many of the other ADs. I think the MAOIs are underprescribed. They went out of style when other ADs came on the market, and most pdocs by now don't have experience with them.
>
>
> How has it worked for you in terms of fighting depression?
>
That's hard to say. Marplan by itself didn't do much, but the combo of Marplan and Cytomel (thyroid hormone) works better than anything I've taken in nearly 10 years. I'm not sure whether I wouldn't do as well with Cytomel and some other AD. I'm not willing to try the experiment right now, though.

I still think the MAOIs have a lot to offer. They affect all three of the neurotransmitters implicated in depression (serotonin, norepinephrine, and dopamine).

I.

 

Re: King Vultan-MAOI Diet? King Vultan

Posted by KaraS on July 10, 2004, at 0:49:38

In reply to Re: King Vultan-MAOI Diet? King Vultan, posted by Ilene on July 10, 2004, at 0:10:37

> > > I chose Marplan because it seemed to fall between Nardil and Parnate in terms of side effects. The only problem I had was dizziness because it lowered my blood pressure. That went away when I went from 50mg to 40mg.
> > >
> > > Marplan is much more tolerable than many of the other ADs. I think the MAOIs are underprescribed. They went out of style when other ADs came on the market, and most pdocs by now don't have experience with them.
> >
> >
> > How has it worked for you in terms of fighting depression?
> >
> That's hard to say. Marplan by itself didn't do much, but the combo of Marplan and Cytomel (thyroid hormone) works better than anything I've taken in nearly 10 years. I'm not sure whether I wouldn't do as well with Cytomel and some other AD. I'm not willing to try the experiment right now, though.
>
> I still think the MAOIs have a lot to offer. They affect all three of the neurotransmitters implicated in depression (serotonin, norepinephrine, and dopamine).
>
> I.

Thanks. You've got me very curious about the Marplan as well as the Cytomel. Your Cytomel isn't sustained release, is it? Do you take it all at once? Do you feel energized quickly when you take it as if you just drank a cup of coffee or is it more subtle?

I had been thinking of trying Parnate but after reading about the tachycardia people have experienced, which I am prone to, I'm thinking that Marplan might be a better match for me along with the Cytomel (instead of the Armour thyroid).
(I don't remember if you needed to be on thyroid meds for low thyroid or you're just using it to potentiate the Marplan.)

Despite how useful the MAOIs are, they probably won't ever make a big comeback because people are worried about the diet and especially because no drug company is going to get rich off of them now that their patents have expired.

Thanks again,
Kara

 

Re: King Vultan-MAOI Diet? King Vultan KaraS

Posted by Ilene on July 10, 2004, at 22:30:10

In reply to Re: King Vultan-MAOI Diet? King Vultan, posted by KaraS on July 10, 2004, at 0:49:38

> Thanks. You've got me very curious about the Marplan as well as the Cytomel. Your Cytomel isn't sustained release, is it? Do you take it all at once? Do you feel energized quickly when you take it as if you just drank a cup of coffee or is it more subtle?
>

I take it all at once. It's not sustained release. I don't feel anything, but if I drink coffee within an hour or so of taking the Cytomel I feel jittery and light-headed.


> I had been thinking of trying Parnate but after reading about the tachycardia people have experienced, which I am prone to, I'm thinking that Marplan might be a better match for me along with the Cytomel (instead of the Armour thyroid).
> (I don't remember if you needed to be on thyroid meds for low thyroid or you're just using it to potentiate the Marplan.)
>

I'm taking it to potentiate the Marplan.

I.

 

Re: King Vultan-MAOI Diet? King Vultan

Posted by KaraS on July 11, 2004, at 2:52:21

In reply to Re: King Vultan-MAOI Diet? King Vultan KaraS, posted by Ilene on July 10, 2004, at 22:30:10

Good to know. Thanks. I think that I will try it in the future. If it doesn't help, I can always go back to the Armour.

 

Re: King Vultan-MAOI Diet? King Vultan

Posted by don_bristol on July 14, 2004, at 12:36:46

In reply to Re: King Vultan-MAOI Diet? King Vultan bluebird, posted by King Vultan on July 9, 2004, at 12:14:36

King Vultan wrote

http://www.vh.org/adult/provider/psychiatry/CPS/19.html

"This article is one of the two best I have seen for information on MAOIs".

----

What is the other article? Do you have a link please?

 

Re: King Vultan-MAOI Diet?

Posted by King Vultan on July 14, 2004, at 14:22:44

In reply to Re: King Vultan-MAOI Diet? King Vultan, posted by don_bristol on July 14, 2004, at 12:36:46

> King Vultan wrote
>
> http://www.vh.org/adult/provider/psychiatry/CPS/19.html
>
> "This article is one of the two best I have seen for information on MAOIs".
>
>
>
> ----
>
> What is the other article? Do you have a link please?


Here is the other one:

http://www.currentpsychiatry.com/2002_06/06_02_maoi.asp


Todd

 

What max dose of PARNATE before giving up? King Vultan

Posted by don_bristol on July 17, 2004, at 4:50:40

In reply to Re: King Vultan-MAOI Diet?, posted by King Vultan on July 14, 2004, at 14:22:44

King Vultan wrote:

> >
> > http://www.vh.org/adult/provider/psychiatry/CPS/19.html
> > "This article is one of the two best I have seen for
> > information on MAOIs".
> >
>
> Here is the other one:
> http://www.currentpsychiatry.com/2002_06/06_02_maoi.asp
>

-------

Hi King Vultan (Todd)

Thank you for the link. You see quite clues-up on these things - do you mind if I ask you to say very briefly what MAOIs you have tried.

I am on Parnate (tranylcypromine) but my psychiatrist is very cautious. After a few months on 20 mg with little effect I had to ask to go from 20 to 30 mg and then she was wary of doing that.

So I am interested in the Cole and Bodkin article http://www.currentpsychiatry.com/2002_06/06_02_maoi.asp where they refer to dosage. They say

--- QUOTE ---
A rule of thumb is to start with one MAOI pill the first day and increase the dosage by one pill every 4 to 7 days until these levels are reached:

1 mg/kg/d for phenelzine;
40 mg/d for tranylcypromine and isocarboxazid;
45 mg/d for selegiline.
---- END QUOTE ----

However their table 2 says this:

--- QUOTE ---
Isocarboxazid 20 to 80 mg/d
Phenelzine 30 to 90 mg/d
Selegiline 15 to 60 mg/d
Tranylcypromine 20 to 100 mg/d
--- END QUOTE ----

It is their upper limit of Parnate/tranylcypomine which I am interested in. It seems a long way from a rule of thumb value of 40mg to the upper limit of 100 mg.

Do you or anyone else here have any views on this?

I suppose my question is not really "what is the upper limit" but what dose of Parnate should I go to before I determine it is not working for me?

 

Re: What max dose of PARNATE before giving up? don_bristol

Posted by SLS on July 17, 2004, at 6:08:23

In reply to What max dose of PARNATE before giving up? King Vultan, posted by don_bristol on July 17, 2004, at 4:50:40

Hi.

I hope you don't mind if I jump in here.

> I suppose my question is not really "what is the upper limit" but what dose of Parnate should I go to before I determine it is not working for me?

No psychiatric specialist should be afraid to go up to 60mg of Parnate (tranylcypromine). 60mg is stated quite clearly in the PDR to be the maximum recommended dosage.

http://www.rxlist.com/cgi/generic2/tranylcypromine_ids.htm

The range usually quoted is 30-60mg. However, for severe cases, I think you will find that people are more likely to respond in the range of 40-80mg. High-dosage strategies are sometimes employed in cases of treatment-resistant depression (TRD). This involves using dosages of 100mg and higher. I have been up to 150mg. To that was added desipramine 300mg + amphetamine 20mg + thyroid hormone. While I wouldn't blame the average psychiatrist for being hesitant to do this, I would blame him were he not to explore Parnate to at least 60mg.

Perhaps you could print out a few things that you have found on the Internet and cue him in on the PDR regarding the maximum recommended dosage of Parnate. Tell him that you understand his desire to be cautious, but that you are willing to go higher. I would also bring in a list of the foods and medications you are avoiding to demonstrate to him the responsibility you are taking for your own safety when using this drug.

Not many people with severe depression respond to 30mg of Parnate. 40mg is the minimum.


- Scott

 

Re: What max dose of PARNATE before giving up? don_bristol

Posted by King Vultan on July 17, 2004, at 10:51:02

In reply to What max dose of PARNATE before giving up? King Vultan, posted by don_bristol on July 17, 2004, at 4:50:40

I completely agree with what Scott has to say and would take it to heart, particularly given his extensive personal experience with the drug--I have only taken Nardil myself out of the MAOIs. I also feel that 40 mg/day is more or less the minimum to gain some understanding of the effectiveness of the drug, and it should be the goal from the beginning of treatment to attain this dosage.

I recently had an appointment with my pdoc and we decided to go beyond the standard maximum of Nardil at 90 mg/day and up to 105 mg/day. It took over a week, but I am beginning to notice a substantial improvement. In terms of the dosage scheme they talk about in one of the articles, I am now at about 1.5 mg/day per kilogram of body weight--this is 50 % beyond what they recommend. However, I will say that I did have therapeutic effects at 1.0 mg/kg body weight per day (75 mg/day); it's just that my mood and outlook are quite a bit more positive at the higher dosage.

Todd

 

Max dose Parnate in the UK is only 30 mg !! SLS

Posted by don_bristol on July 22, 2004, at 13:22:01

In reply to Re: What max dose of PARNATE before giving up? don_bristol, posted by SLS on July 17, 2004, at 6:08:23

Don Bristol wrote:
>>
>> I suppose my question is not really "what is the upper limit"
>> but what dose of Parnate should I go to before I determine it
>> is not working for me?

Scott wrote:
>
> No psychiatric specialist should be afraid to go up to 60mg of
> Parnate (tranylcypromine). 60mg is stated quite clearly in the
> PDR to be the maximum recommended dosage.
>
> http://www.rxlist.com/cgi/generic2/tranylcypromine_ids.htm
>
> The range usually quoted is 30-60mg. However, for severe cases,
> I think you will find that people are more likely to respond in
> the range of 40-80mg.


Scott, thank you for the reply. I am in the UK and we have the BNF as our doctor's guide. It is sort of equivalent to the US's PDR. (Go to http://www.bnf.org/ and click BNF 47 and then search away.)

The BNF says this of Parnate/tranylcypromine:

"Dose: initially 10 mg twice daily not later than 3 p.m., increasing the second daily dose to 20 mg after 1 week if necessary; doses above 30 mg daily under close supervision only; usual maintenance dose 10 mg daily"

This is sort counter what most people here seems to have experienced that I have no idea how it is that we in the UK suggest such low doses. However it means that I might have an uphill struggle to convince my psychiatrist to go much above 30 mg for me.

If you or anyone else here have any other authoritative sources of info which I could print out then I would like to know about them.

Of course, I will also do as you wisely suggested and show the doc I am knowledgeable about the dietary risks and am a responsible patient.


> While I
> wouldn't blame the average psychiatrist for being hesitant to do
> this, I would blame him were he not to explore Parnate to at
> least 60mg.
>
> - snip --
>
> Not many people with severe depression respond to 30mg of Parnate.
> 40mg is the minimum.


 

Re: Max dose Parnate in the UK is only 30 mg !!

Posted by Piquet on July 22, 2004, at 20:33:01

In reply to Max dose Parnate in the UK is only 30 mg !! SLS, posted by don_bristol on July 22, 2004, at 13:22:01

Don, I'm in Australia and recently saw a psych. who specialises in treating resistant depression. He put me on Parnate 10mg on day 1, 20mg on day 2, 30mg on day 3 and 40mg on day 4. When I see him again in a week from now, I'll have been on 40mg b.i.d. for 3 weeks. He doesn't strike me as being a reckless doctor, but has bemoaned more than once the fact that much treatment fails due to underdosage. With almost 40 years experience of depression behind me, I'm inclined to agree with him. I'm sure he'll have no hesitation in raising my dosage if he feels it is warranted. Presently I take no other drugs and am having no trouble tolerating the Parnate. I am about six feet tall and weigh 105 kg. I hope you find this info useful and I wish you success in your treatment.

Piquet.

 

Another good MAOI link King Vultan

Posted by don_bristol on July 27, 2004, at 14:17:07

In reply to Re: King Vultan-MAOI Diet?, posted by King Vultan on July 14, 2004, at 14:22:44

> > King Vultan wrote
> >
> > http://www.vh.org/adult/provider/psychiatry/CPS/19.html
> >
> > "This article is one of the two best I have seen for information on MAOIs".
> >
> >
> >
> > ----
> >
> > What is the other article? Do you have a link please?
>
>
> Here is the other one:
>
> http://www.currentpsychiatry.com/2002_06/06_02_maoi.asp
>
>
> Todd
>

KING VULTAN, HAVE YOU SEE THIS RATHER GOOD MAOI ARTICLE?

http://www.acnp.com/G4/GN401000046/CH046.html

RGDS, DON

 

Re: Thanks, Don (nm) don_bristol

Posted by King Vultan on July 29, 2004, at 7:36:11

In reply to Another good MAOI link King Vultan, posted by don_bristol on July 27, 2004, at 14:17:07


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