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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by Ilene on August 4, 2004, at 16:00:30
I've been taking Marplan for a few months. It didn't do much good until I augmented it with Cytomel (T3 thyroid hormone). I was up to 50 mg, then bumped down to 40 mg. because of dizzy spells. I did okay for a couple of months at 40 mg., but I've been depressed for about a month. I know the depression is related to moving, but I haven't been able to pull out of it.
Has anyone suffered MAOI poop-out? Did raising the dose help? Or did it just stop working, like other ADs?
Thanks
Posted by Racer on August 4, 2004, at 17:09:02
In reply to MAOI poop-out?, posted by Ilene on August 4, 2004, at 16:00:30
Based solely on a very incomplete understanding of all this stuff, I don't think MAOIs stop working the same way SSRIs do. (And don't even *think* about asking me about TCAs!)
SSRIs work by inhibiting the reuptake of serotonin, right? That means that they're affecting the serotonin receptors, which first spew out some serotonin -- then suck some of it back in, to keep the balance of serotonin in the synapse where they think it should be. The SSRIs depend on the serotonin that's already there, and then on that receptor 'listening' to the drug. What seems to happen with this mechanism -- again, I'm so close to totally ignorant about this stuff, so don't consider this the final answer -- is that the serotonin receptors pay attention for a while, but then get desensitized to the message and go back to what they were doing in the first place.
MAOIs, on the other hand, inhibit the action of an enzyme that contributes to the breakdown of the Big Three neurotransmitters -- serotonin, norepinephrine, and dopamine. Without that enzyme going about bashing our friendly little one-amino-acid neurotransmitters, the little guys can come out and play to their hearts content. Again, it depends on having enough of the neurotransmitters in the first place, but it's not so dependant on the receptors.
I think that the biggest difference is that MAOIs don't depend on the reuptake inhibition, so much on the survival of the neurotransmitter molecule itself. Does that make sense?
Anyway, while I will not say that MAOIs shouldn't poop out the way some other drugs can, I hope this will hold you over until someone who actually *knows* anything about this comes along.
Posted by gardenergirl on August 4, 2004, at 17:58:14
In reply to Re: MAOI poop-out?, posted by Racer on August 4, 2004, at 17:09:02
Ilene,
Sorry you are struggling right now. I actually am, too, and have been wondering if it's the Nardil pooping out. I saw a pdoc yesterday, who recommended upping the Nardil to 75 mg for a trial. But she also thinks my current depression is more psychological in nature, thanks to having to care for my mother after her surgery. (Mom is toxic). So, it could be just the stress of moving. It's a lot of hassles, plus the loss of the familiar and loss of perhaps friends? Throw in new docs and I think I'd be depressed, too.Take care,
gg
Posted by Ilene on August 4, 2004, at 20:53:50
In reply to Re: MAOI poop-out?, posted by gardenergirl on August 4, 2004, at 17:58:14
> Ilene,
> Sorry you are struggling right now. I actually am, too, and have been wondering if it's the Nardil pooping out. I saw a pdoc yesterday, who recommended upping the Nardil to 75 mg for a trial. But she also thinks my current depression is more psychological in nature, thanks to having to care for my mother after her surgery. (Mom is toxic). So, it could be just the stress of moving. It's a lot of hassles, plus the loss of the familiar and loss of perhaps friends? Throw in new docs and I think I'd be depressed, too.
>
> Take care,
>
> ggYes, I saw one of your posts over on psychology. How are you tolerating the increased dosage? Any positive effects yet?
Join the toxic-mom club. I never actually missed my mom when she died. I wish I could have dealt with her in a more adult-like manner, though. She and my sister got along a lot better. (My sister's dead too. I don't think she inherited the "depression gene".)
Toxic people sometimes victimize themselves as much as they victimize other people. I think my mother lacked insight into her own behavior. I know she was emotionally abused by her own mother, so that was her mothering style, to oversimplify. Plus she probably had an anxiety disorder.
This is the way I see it: Normal people get stressed, but they don't get depressed, or if they do the depression goes away with the stressor. They don't feel suicidal, either, or get symptoms other than the emotional state of feeling down.
If the ADs are working a person should be "normal", or nearly so.
The move is quite stressful. I have a few friends here, but they tend to be busy with their own lives. I didn't really have friends in Washington because I was too sick or depressed to do the things where people make friends. (I think I'm a little difficult to get along with, too.)
I have no difficulty falling into a depression, but I've never been able to master falling out of one. Drugs are the only thing that's ever worked.
Posted by Ilene on August 4, 2004, at 21:10:08
In reply to Re: MAOI poop-out?, posted by Racer on August 4, 2004, at 17:09:02
> SSRIs work by inhibiting the reuptake of serotonin, right? That means that they're affecting the serotonin receptors, which first spew out some serotonin -- then suck some of it back in, to keep the balance of serotonin in the synapse where they think it should be. The SSRIs depend on the serotonin that's already there, and then on that receptor 'listening' to the drug. What seems to happen with this mechanism -- again, I'm so close to totally ignorant about this stuff, so don't consider this the final answer -- is that the serotonin receptors pay attention for a while, but then get desensitized to the message and go back to what they were doing in the first place.
>Some people now think that SSRI-induced changes occur elsewhere in the brain.
> MAOIs, on the other hand, inhibit the action of an enzyme that contributes to the breakdown of the Big Three neurotransmitters -- serotonin, norepinephrine, and dopamine. Without that enzyme going about bashing our friendly little one-amino-acid neurotransmitters, the little guys can come out and play to their hearts content. Again, it depends on having enough of the neurotransmitters in the first place, but it's not so dependant on the receptors.
>
> I think that the biggest difference is that MAOIs don't depend on the reuptake inhibition, so much on the survival of the neurotransmitter molecule itself. Does that make sense?
>In theory, I should be happy.
> Anyway, while I will not say that MAOIs shouldn't poop out the way some other drugs can, I hope this will hold you over until someone who actually *knows* anything about this comes along.I'm hoping they have a better record, poop-out wise. It could be that when I went from 40 to 50 mg. I got below my effectiveness threshold, but it took a few months for it to happen. Or that the extra stress of moving means I need to boost the dose.
At least the Zyprexa is still working. I don't have nearly the anxiety I did a few months back.
And how are you?
Posted by Ilene on August 4, 2004, at 21:11:03
In reply to Re: MAOI poop-out?, posted by Racer on August 4, 2004, at 17:09:02
Posted by gardenergirl on August 5, 2004, at 8:53:37
In reply to Re: MAOI poop-out?, posted by Ilene on August 4, 2004, at 21:10:08
>
> In theory, I should be happy.Just had to comment on the above. Such a profound statement!
gg
>
Posted by gardenergirl on August 5, 2004, at 9:00:55
In reply to Re: MAOI poop-out? » gardenergirl, posted by Ilene on August 4, 2004, at 20:53:50
> Yes, I saw one of your posts over on psychology. How are you tolerating the increased dosage? Any positive effects yet?
Well, I started the 75mg on Tuesday and today I woke up feeling pretty good. I actually made pancakes for breakfast! I hope I can carry that good mood and motivation into working on my school stuff. The only side effect I notice so far is the carb craving coming back full strength...hence the pancakes. :) Although the thyroid mess going on described in another thread may have messed up my cycle and I could also be PMSing early. We'll see, I suppose.
>
>
> Toxic people sometimes victimize themselves as much as they victimize other people. I think my mother lacked insight into her own behavior. I know she was emotionally abused by her own mother, so that was her mothering style, to oversimplify. Plus she probably had an anxiety disorder.Yeah, my mom grew up with an alcoholic father, too, although he got sober in her lifetime (still waiting on mine). And I really don't think she has any idea how narcissistic she can be.
>
> This is the way I see it: Normal people get stressed, but they don't get depressed, or if they do the depression goes away with the stressor. They don't feel suicidal, either, or get symptoms other than the emotional state of feeling down.
>
> If the ADs are working a person should be "normal", or nearly so.This makes sense, although I wonder if the AD's can counter a susceptiblity to depression or if they just work on the effects. Kind of like the diasthesis-stress model. If you have the susceptibility, as I know I do, then stress can activate it. AD's must mitigate this some, but from my recent experience, it doesn't seem like it does completely. But just theorizing here.
>Here's hoping you get settled in very soon. It sounds like you will be getting expert care!
Take care,
gg
Posted by Ilene on August 5, 2004, at 13:56:30
In reply to Re: MAOI poop-out?, posted by gardenergirl on August 5, 2004, at 9:00:55
> > Yes, I saw one of your posts over on psychology. How are you tolerating the increased dosage? Any positive effects yet?
>
> Well, I started the 75mg on Tuesday and today I woke up feeling pretty good. I actually made pancakes for breakfast! I hope I can carry that good mood and motivation into working on my school stuff. The only side effect I notice so far is the carb craving coming back full strength...hence the pancakes. :) Although the thyroid mess going on described in another thread may have messed up my cycle and I could also be PMSing early. We'll see, I suppose.
> >
> >
For a while I worked hard on staying away from starches. I ate more protein, veggies, and fruit, and I actually lost weight. It's just so much easier to reach for that box of cereal in the morning, though. I think the small dose of Zyprexa I'm taking has put on a few pounds, but it's worth it not to be anxious all the time.> Yeah, my mom grew up with an alcoholic father, too, although he got sober in her lifetime (still waiting on mine). And I really don't think she has any idea how narcissistic she can be.
> >Of course not.
> This makes sense, although I wonder if the AD's can counter a susceptiblity to depression or if they just work on the effects. Kind of like the diasthesis-stress model. If you have the susceptibility, as I know I do, then stress can activate it. AD's must mitigate this some, but from my recent experience, it doesn't seem like it does completely. But just theorizing here.
> >ADs obviously don't "cure" depression. I know I will never stop taking them. I wouldn't be surprised if in a few years genetic and other studies show that there is more than one kind of depressive disease. I'm very much on the side of nature in any nature vs. nurture controversy (oversimplifying again). In my case the depression is very powerful.
>
> Here's hoping you get settled in very soon. It sounds like you will be getting expert care!
>
>
I'm nervous about seeing a new pdoc, esp. a resident.Good luck on your thyroid treatment.
I.
Posted by Racer on August 5, 2004, at 14:12:06
In reply to Re: MAOI poop-out?, posted by Ilene on August 4, 2004, at 21:10:08
> > SSRIs work by inhibiting the reuptake of serotonin, right? That means that they're affecting the serotonin receptors, which first spew out some serotonin -- then suck some of it back in, to keep the balance of serotonin in the synapse where they think it should be. The SSRIs depend on the serotonin that's already there, and then on that receptor 'listening' to the drug. What seems to happen with this mechanism -- again, I'm so close to totally ignorant about this stuff, so don't consider this the final answer -- is that the serotonin receptors pay attention for a while, but then get desensitized to the message and go back to what they were doing in the first place.
> >
>
> Some people now think that SSRI-induced changes occur elsewhere in the brain.
>Well, yes and no: keeping the Serotonin active in those synapses by keeping the receptors from sucking it back up *does* change other areas in the brain. Serotonin has a lot of effects throughout the body -- 90% of the serotonin in the body is active in the gastrointestinal tract, for example -- but the mechanism for the drugs remains in the receptors. So, those other effects happen as secondary to the reuptake thing.
Serotonin does interact with the whole stress-system, influencing the whole limbic-hypothalamic-pituotaru-adrenal axis which produces glucocoricoids that are involved in stress response. That whole system is only partially understoond. FOr a long time, it was throught to be a very closed loop system, but now it's been found to be influenced by a lot of elements outside that loop. Don't ask me what other things serotonin does, though...
And norepinephrine and dopamine are also involved in that feedback system, since theres' an element that creates dopamine, norepinehprine and epinephrine, but I can't remember anything about that today. If it comes back tomorrow, I'll try to jump in with it.
>
> > MAOIs, on the other hand, inhibit the action of an enzyme that contributes to the breakdown of the Big Three neurotransmitters -- serotonin, norepinephrine, and dopamine. Without that enzyme going about bashing our friendly little one-amino-acid neurotransmitters, the little guys can come out and play to their hearts content. Again, it depends on having enough of the neurotransmitters in the first place, but it's not so dependant on the receptors.
> >
> > I think that the biggest difference is that MAOIs don't depend on the reuptake inhibition, so much on the survival of the neurotransmitter molecule itself. Does that make sense?
> >
>
> In theory, I should be happy.
>Actually, stress will counteract anything that happens. In the list of Major Life Stressors, moving is high on the list, along with divorce, loss of a loved one, etc. My guess is that moving alone is more than enough to create the kind of problem you're having now.
>
> > Anyway, while I will not say that MAOIs shouldn't poop out the way some other drugs can, I hope this will hold you over until someone who actually *knows* anything about this comes along.
>
> I'm hoping they have a better record, poop-out wise. It could be that when I went from 40 to 50 mg. I got below my effectiveness threshold, but it took a few months for it to happen. Or that the extra stress of moving means I need to boost the dose.
>
> At least the Zyprexa is still working. I don't have nearly the anxiety I did a few months back.
>
> And how are you?Me? Lousy. Right now, since 6PM last night, I'm downing enough Xanax to knock me out until there's a hope I can function at the same level of depression I was functioning at for the last few weeks. Yesterday was so bad, I figured the safest thing for me was to sleep through as much of it as I could. SO, massive doses of Xanax to keep me asleep until I thought i could be awake for a while. THis just happens to be the point where one dose wore off enough to wake me up, before the next dose took effect. Once the next dose kicks in, back to sleep for me.
Posted by Ilene on August 5, 2004, at 17:32:02
In reply to Re: MAOI poop-out?, posted by Racer on August 5, 2004, at 14:12:06
> Me? Lousy. Right now, since 6PM last night, I'm downing enough Xanax to knock me out until there's a hope I can function at the same level of depression I was functioning at for the last few weeks. Yesterday was so bad, I figured the safest thing for me was to sleep through as much of it as I could. SO, massive doses of Xanax to keep me asleep until I thought i could be awake for a while. THis just happens to be the point where one dose wore off enough to wake me up, before the next dose took effect. Once the next dose kicks in, back to sleep for me.
Have you tried Zyprexa for anxiety? It's my miracle drug. I was taking Klonopin off-and-on for over a year, then added Risperdal, then replaced the Risperdal with Zyprexa, and voila! my anxiety might actually be "normal". I can't tell, I don't know how other people feel, but I don't have a constant feeling of dread.
I remember wanting to sleep through it all. Is there a reason why this is happening? Maybe you posted elsewhere and I missed it.
I'm feeling a lot better today than yesterday. It might be because I've been taking my Cytomel on an empty stomach, taking my vitamins regularly, or maybe just because the sun is shining--finally!
Hope you feel a little better when you wake up.
This is the end of the thread.
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