Psycho-Babble Medication Thread 579730

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Re: MAOIs and psycho-surgery Jedi

Posted by Bob on November 19, 2005, at 18:02:08

In reply to Re: MAOIs and psycho-surgery Bob, posted by Jedi on November 19, 2005, at 17:02:45

> >I just can't imagine being on such a heavy duty medecine like that for the rest of my life. I mean, does anyone really take these things for decades, or does it always end up bad in the end? I also can't imagine being on a super-restrictive diet for a very long time. The last thing I need is a stroke. I wonder, if the MAOIs had remained a first line treatment if the drug companies would have found safe versions by now.
>
> Thank you for the website.
>
>
>
> Bob,
> As a person that has been on Nardil plus augmentation for the good part of the last decade, I am having a hard time with your thinking on MAOIs. There is a school of thought that a person can not even be considered treatment resistant without a couple of five week trials on Nardil and Parnate. Without Nardil I would not be living right now. I do not know the history of your depression, but if it is atypical with social anxiety, an MAOI should have been the 2nd tier medication trial. It is not a last resort, it is the gold standard that other medications are compared to. The side effects and diet restrictions are way overblown. I plan on being on Nardil with various augmentations the rest of my life.
> Wishing you Well,
> Jedi
>
>

Jedi

Your info is heartening. I assume you are not getting extreme side effects, or otherwise you'd be off of it? If you don't mind me asking, what types of things did you augment Nardil with, assuming that none of the SSRIs are available?

Again, it's not that I am somehow against the MAOIs, just that I've had a bad time with so many meds for so long that I'm real skittish now.

I basically have major depression, major anxiety, and some obsessional/rumination problems. Most of the meds I've taken have affected me greatly in one way or another - it's not like I'm some sort of inert rock and completely insensitive to all meds. I've just never been able to find a med that helped with my mental (and now physical problems) while at the same time actually allowing me to function in life. My standards were much higher in the beginning. Now I just want to be able to get out of the house on a daily basis.

 

psychosurgery, etc.

Posted by med_empowered on November 19, 2005, at 18:03:37

In reply to Re: MAOIs and psycho-surgery Bob, posted by Jedi on November 19, 2005, at 17:02:45

hey! The reason I don't think psychosurgery i susch a great idea is b/c its irreversible and there haven't been any really *good* double-blind studies. I also have problems with destroying healthy brain tissue to alter personality and mood...the idea of brain damage as therapy repulses me. MAOIs aren't too bad, but I can understand people wanting to avoid them. Aurorix (moclobedmide, others) is a reversible MAOI w/ fewer problems. The dose has to be pretty high to get effects--apparently a bunch of studies made it seem ineffective b/c they used low doses. Plus, it can be used with tricyclics and I think SSRIs. Its available in canada, europe, asia...pretty much everywhere except the US. If you're in the US, your doc might go for finding a way to get it to you and then monitoring your progress. Its available in generic, so even if your insurance won't cover that the costs shouldn't be too bad (I would think..I dont really know, though). The most hardcore Antidepressant regimine I can think of would be an MAOI+Tricyclic+low-dose stimulant; with moclobemide, you could probably do this w/ minimal side effects (and if you can use provigil as the stimulant, that will also reduce side effects). Good luck!

 

opioids for depression Bob

Posted by pseudoname on November 19, 2005, at 20:59:44

In reply to Re: When the options are gone? 4WD, posted by Bob on November 19, 2005, at 0:38:19

I think we're in similar positions. I go days without leaving the house. I've tried ECT and about 3 dozen med regimes plus lots of therapy etc. Almost nothing did any good. Right now I'm just starting opioid therapy with buprenorphine.

> What exactly is opiate therapy? ... Is there a website or something where I can check it out?

See Stoll's 1999 case studies reprinted here: http://www.dr-bob.org/babble/20010522/msgs/64652.html

The buprenorphine I'm trying is a weaker & more complex opioid. See "Buprenorphine Treatment of Refractory Depression" by Bodkin et al, Journal of Clinical Psychopharmacology, Feb 1995, vol 15, p 49-57: http://balder.prohosting.com/~adhpage/bupe.html

One huge Babble opioids-for-depression thread starts here: http://www.dr-bob.org/babble/20011015/msgs/81414.html.

Adding naltrexone (which acts on opioid receptors) to an SSRI may be a better bet if you've had at least *some* response to the SSRI already (e.g., weak or pooped-out).

It sounds like you're thinking now of an MAOI? If you also become interested in opioid therapy ("opioid" is a more inclusive term than "opiate"), I'd suggest going ahead with MAOI trials while you gather info and talk to your docs about opioids. They may initially be reluctant or unaware of the literature or even misinformed about the law. And if an MAOI works, well, it'd easier to get, anyway.

 

Re: MAOIs Bob

Posted by Jedi on November 20, 2005, at 1:50:44

In reply to Re: MAOIs and psycho-surgery Jedi, posted by Bob on November 19, 2005, at 18:02:08

> Your info is heartening. I assume you are not getting extreme side effects, or otherwise you'd be off of it? If you don't mind me asking, what types of things did you augment Nardil with, assuming that none of the SSRIs are available?
>
> Again, it's not that I am somehow against the MAOIs, just that I've had a bad time with so many meds for so long that I'm real skittish now.
>
> I basically have major depression, major anxiety, and some obsessional/rumination problems.

Hi Bob,
I do get side effects from the Nardil. I am on a fairly high dosage of between 75 and 105mg. Most of the side effects have gone away over time. I no longer get orthostatic hypertension. In fact Nardil will decrease borderline hypertension, so that if you are affected with this ailment, another med for this is probably not necessary.

The main side effects that are still with me are carbohydrate cravings which cause my weight gain and delayed ejaculation. The weight gain can be controlled with vigorous exercise. When you are severely depressed, forcing yourself to exercise can be very difficult. Weight gain is also a symptom of my atypical depression. The delayed ejaculation has not been much of a problem for me, there are augmentations to handle this, also.

What it comes down to is a choice. I can fight though some minor side effects or lay in bed for 16 hours a day and watch my life and family disappear.

Currently, I am augmenting with 1mg of clonazepam. There is some current research that augmenting with up to 3mg of clonazepam can help resistant depression. I may try this for a month while reducing my Nardil dosage, just to see what happens. I've also augmented with nortriptyline which is the major metabolite of amitriptyline & effects mostly NE. I've used bupropion with Nardil also. This is officially contraindicated but helped with my Nardil induced weight gain. I found the bupropion caused some initial agressiveness but the Nardil counteracted the anxiety producing effects of bupropion. Never augment Nardil or Parnate with an SSRI. They potentiate serotonin in the brain by different pathways. Serotonin syndrome is the result. Anyway Bob, there are many things left to try. It can be a long hard road, but we do what's put in front of us.
Take care,
Jedi

 

Re: MAOIs and psycho-surgery

Posted by linkadge on November 20, 2005, at 15:47:40

In reply to Re: MAOIs and psycho-surgery ed_uk, posted by Bob on November 19, 2005, at 15:58:11

I don't mean to sound rude, but having to avoid a few types of food for an extended period of time seems to me to pale in comaprison to me to having to live with the kind of illness you're describing.

+ there are meds you can cary with you to abort hypertensive crisis.

Linkadge

 

Re: MAOIs and psycho-surgery linkadge

Posted by Bob on November 20, 2005, at 16:52:23

In reply to Re: MAOIs and psycho-surgery, posted by linkadge on November 20, 2005, at 15:47:40

> I don't mean to sound rude, but having to avoid a few types of food for an extended period of time seems to me to pale in comaprison to me to having to live with the kind of illness you're describing.
>
> + there are meds you can cary with you to abort hypertensive crisis.
>
> Linkadge

Don't worry, I don't think your comment is rude, but I do think it can be misleading. I've heard that rationale many times, but once I'm on a medecine and presented with myriad side effects but still miserable, I then wonder why it's worth it. For example, both Effexor and Anafranil produced prodigious weight gain, inability to ejaculate, a lack of motivation, impaired ability to concentrate, profuse sweating, and so on. Most seriously, over time it got harder and harder to wake up in the morning, no matter what time I went to bed, until eventually I was not able to make it to work until mid-afternoon. Other SSRIs have done this also, but not quite to the same extent. I have tried many, many things to deal with this, but nothing, and no one has ever helped. So I have to wonder whether being on the med is worth it. About the only thing it does do is emotionally blunt me and, for the most part get rid of suicidality. What kind of life is that? I guess better than being suicidal.

The only way I ever got a girlfriend during all this time was when I stubbornly went of SSRIs and temporarily using Lithium with low-dose Celexa and Welbutrin. I achieved a small window where I had little motivation and was able to perform sexually (although poorly). The window soon faded.

Its easy to say that putting up with a few side effects is no big deal, but side effects coupled with ineffective meds is another issue. I think in my case, I am having bad reactions to meds, also. It seems that now, whenever I take a med with any SSRI action, I suffer physical effects, like general discomfort all over my body, especially after physical exertion, or exposure to heat, such as in a hot shower. It's a reaction that is very disturbing to me, yet no professional has ever even remotely suggested to me what it might be. This is one reason why I sough out meds like Topomax and Neurontin, as well as the ECT treatments. I've been desperately, desperately trying to find ways to subsist of meds. Not only have my efforts failed, but they have really, really close to bringing and end to everything. These were not issued I was dealing with way back when I first started these things. I guess many diseases evolve, or as I'd like to think, devolve.

 

Re: MAOIs Jedi

Posted by Bob on November 20, 2005, at 20:06:25

In reply to Re: MAOIs Bob, posted by Jedi on November 20, 2005, at 1:50:44

> > Your info is heartening. I assume you are not getting extreme side effects, or otherwise you'd be off of it? If you don't mind me asking, what types of things did you augment Nardil with, assuming that none of the SSRIs are available?
> >
> > Again, it's not that I am somehow against the MAOIs, just that I've had a bad time with so many meds for so long that I'm real skittish now.
> >
> > I basically have major depression, major anxiety, and some obsessional/rumination problems.
>
> Hi Bob,
> I do get side effects from the Nardil. I am on a fairly high dosage of between 75 and 105mg. Most of the side effects have gone away over time. I no longer get orthostatic hypertension. In fact Nardil will decrease borderline hypertension, so that if you are affected with this ailment, another med for this is probably not necessary.
>
> The main side effects that are still with me are carbohydrate cravings which cause my weight gain and delayed ejaculation. The weight gain can be controlled with vigorous exercise. When you are severely depressed, forcing yourself to exercise can be very difficult. Weight gain is also a symptom of my atypical depression. The delayed ejaculation has not been much of a problem for me, there are augmentations to handle this, also.
>
> What it comes down to is a choice. I can fight though some minor side effects or lay in bed for 16 hours a day and watch my life and family disappear.
>
> Currently, I am augmenting with 1mg of clonazepam. There is some current research that augmenting with up to 3mg of clonazepam can help resistant depression. I may try this for a month while reducing my Nardil dosage, just to see what happens. I've also augmented with nortriptyline which is the major metabolite of amitriptyline & effects mostly NE. I've used bupropion with Nardil also. This is officially contraindicated but helped with my Nardil induced weight gain. I found the bupropion caused some initial agressiveness but the Nardil counteracted the anxiety producing effects of bupropion. Never augment Nardil or Parnate with an SSRI. They potentiate serotonin in the brain by different pathways. Serotonin syndrome is the result. Anyway Bob, there are many things left to try. It can be a long hard road, but we do what's put in front of us.
> Take care,
> Jedi

Jedi

I feel deeply for you. I know exactly what you mean about a "long hard road". Not only that, but nobody can possibly imagine this plight who hasn't gone through it. I guess that's the way it is for other plights too. Still, the burden of this situation is unbelievably difficult, and to think that it's for life is just brutal. Ok, enough said.

It seems like it would be very difficult to tolerate Nardil along with Nortriptyline! Those are two heavy drugs. I didn't know that adding clonazepam would help depression. I thought benzos would only calm someone down, but that's it.

Are you saying that you have had success controlling your weight with exercise, that you have not been able to exercise because of your depression?

I assume that since you are taking a relatively high dose of Nardil and that you have augmented with different things that you experienced at least a partial fade out with the therapeutic effects of Nardil?

Bob

 

Re: MAOIs Bob

Posted by Jedi on November 21, 2005, at 1:51:22

In reply to Re: MAOIs Jedi, posted by Bob on November 20, 2005, at 20:06:25

> It seems like it would be very difficult to tolerate Nardil along with Nortriptyline! Those are two heavy drugs.

Bob,
I only augmented with 100mg of nortriptyline. I had no additional side effects. There are quite a few controlled studies that show that an MAOI augmented with some tricyclics can be beneficial for treatment resistant depression. There are also some studies which show that augmenting with tricyclics can reduce the problems with ingested tyramine. The nortiptyline did not seem to add any additional benefit for me. So when I got my MAO inhibition up to a therapeutic level, I dropped the nortriptyline.

> I didn't know that adding clonazepam would help depression. I thought benzos would only calm someone down, but that's it.

Many people on this board think that clonazepam causes worsening of depression. There have been some resent studies which show that at least 3mg of clonazepam added to an antidepressant can have a synergistic effect.

Example:
Nihon Shinkei Seishin Yakurigaku Zasshi. 2004 Apr;24(2):75-8.
[Clonazepam as a therapeutic adjunct to improve the management of depression]
Morishita S.
Depression Prevent Medical Center, Jujo Hospital, 32 Hattandacho, Kishoin, Minami-ku, Kyoto, 601-8325 Japan.

Clonazepam, which is a benzodiazepine structurally related to chlordiazepoxide hydrochloride, diazepam and nitrazepam, has been available for the treatment of seizure disorders in the USA since 1976 and in Japan since 1981. Increasingly, clonazepam has been used in the treatment of a variety of psychiatric disorders. The effect of clonazepam on depression was first reported by Jones and Chouinard in 1985. Since their report, many investigators have reported on the antidepressive properties of clonazepam. A daily dose of at least 3.0 mg clonazepam in augmentation of ongoing antidepressant treatment should be considered in depression. Regarding clonazepam augmentation therapy, if a patient does not show improvement by the end of four weeks, the treatment regimen should be altered. Age at onset of the first depressive episode and a history of family psychiatric illness should be considered the predictor of prognosis. The author discusses specific guidelines for the use of clonazepam in depression.

> Are you saying that you have had success controlling your weight with exercise, that you have not been able to exercise because of your depression?

My weight has gone up and down on Nardil. When I am able to exersise for an hour or two per day, the weight comes off. Without medication, my atypical depression makes it almost immpossible to exercise. I just can't force myself out of bed.

> I assume that since you are taking a relatively high dose of Nardil and that you have augmented with different things that you experienced at least a partial fade out with the therapeutic effects of Nardil?

You assume correctly. I would call the level of depression that I suffer on Nardil, intermittent dysthymia. The augmentation that I try is to control this and the side effects. The two times I have been off Nardil in the past decade, I have regressed to major depression within a couple of months.

I have had partial responses with other medications. Effexor and Celexa combined with Wellbutrin SR have given partial response. The main problem with the SSRIs and SNRIs is a level of anhedonia and apathy which keep me from doing anything productive.

As mentioned before, I'm a lifer. I'm still hoping for that miracle medication to come along, but until then it is Nardil with augmentation.
Take care,
Jedi

 

Re: MAOIs Jedi

Posted by Bob on November 21, 2005, at 15:32:05

In reply to Re: MAOIs Bob, posted by Jedi on November 21, 2005, at 1:51:22


>
> I have had partial responses with other medications. Effexor and Celexa combined with Wellbutrin SR have given partial response. The main problem with the SSRIs and SNRIs is a level of anhedonia and apathy which keep me from doing anything productive.
>
> As mentioned before, I'm a lifer. I'm still hoping for that miracle medication to come along, but until then it is Nardil with augmentation.
> Take care,
> Jedi
>
>

I did a stint on Effexor alone, as well as Celexa combined with Welbutrin SR. I too got a partial response from both, but the second one especially started producing unpleasant physical side effects, like breathing problems. One thing that makes these drugs hard for me is getting off of them when the situation turns sour. Effexor was nasty to get off of, and so was Anafranil. They were the worst. Oh, and benzos! Any change down in a benzo dose really hits me hard. It causes almost immediate suicidality.

 

Re: MAOIs Bob

Posted by 4WD on November 21, 2005, at 21:53:46

In reply to Re: MAOIs Jedi, posted by Bob on November 21, 2005, at 15:32:05

Bob, I sympathize completely. People talk about side effects and how it's worth it to feel better. Well, I think so, too. However, and this is the big thing, if you just get the side effects and not much therapeutic action, it's NOT worth it. And the side effects seem to be intensified or at least less bearable if you are still depressed or anxious. What I'd be able to stand (side effect wise) is a whole lot different when I'm depressed versus when I'm feeling well.

So yes, if a med took away my depression and anxiety and I felt well on it but had dry mouth and anorgasmia or whatever, it would be worth it. (Though why we should have to tolerate a lowered quality of living doesn't seem fair). But having dry mouth and anorgasmia and restless legs while one is depressed is just about unbearable.

Marsha

 

Re: MAOIs and psycho-surgery

Posted by linkadge on November 22, 2005, at 15:53:52

In reply to Re: MAOIs and psycho-surgery linkadge, posted by Bob on November 20, 2005, at 16:52:23

I can understand how the cumulative side effect profile can make life miserable in itself, especially when the drug isn't doing what it should.

But for goodness sakes if an MAOI works then take it. You'll never really be able to ballance the positives/negatives unless you try and see.

I found that parnate had no side effects as compared to the SSRI's. And geez giving up a few foods was not a big deal, I very quickly learned to find foods I enjoyed that were allowable.

Severe depression is life threatening in my books. Avoiding sardenes is not.

Linkadge

 

Re: MAOIs

Posted by linkadge on November 22, 2005, at 15:56:53

In reply to Re: MAOIs Bob, posted by 4WD on November 21, 2005, at 21:53:46

I know what you are saying about sleep though. Most AD's screw up your sleep, that is how they work by reducing REM sleep. It mimics sleep deprivation. Its not healthy.

Linkadge

 

Re: MAOIs 4WD

Posted by Bob on November 22, 2005, at 18:25:54

In reply to Re: MAOIs Bob, posted by 4WD on November 21, 2005, at 21:53:46

> Bob, I sympathize completely. People talk about side effects and how it's worth it to feel better. Well, I think so, too. However, and this is the big thing, if you just get the side effects and not much therapeutic action, it's NOT worth it. And the side effects seem to be intensified or at least less bearable if you are still depressed or anxious. What I'd be able to stand (side effect wise) is a whole lot different when I'm depressed versus when I'm feeling well.
>
> So yes, if a med took away my depression and anxiety and I felt well on it but had dry mouth and anorgasmia or whatever, it would be worth it. (Though why we should have to tolerate a lowered quality of living doesn't seem fair). But having dry mouth and anorgasmia and restless legs while one is depressed is just about unbearable.
>
> Marsha

Very well said Marsha. You've summed it up perfectly. We wouldn't have legions of people motivated to try another antidepressant if they truly were being greatly helped by the one they are on, even if there were a few side effects. What you can or will tolerate depends greatly on how well you feel to begin with.

 

Re: MAOIs linkadge

Posted by Bob on November 22, 2005, at 18:29:00

In reply to Re: MAOIs, posted by linkadge on November 22, 2005, at 15:56:53

> I know what you are saying about sleep though. Most AD's screw up your sleep, that is how they work by reducing REM sleep. It mimics sleep deprivation. Its not healthy.
>
> Linkadge

That fact that ADs word by creating sleep deprivation - I don't think I've ever actually heard that. At least not as the mechanism of action. So you are saying that because they reduce REM sleep, that the body actually needs more? If so, why do I personally seem to need about 10 times more than anyone else I've heard about, even others oh meds?


 

Re: MAOIs and psycho-surgery linkadge

Posted by Bob on November 22, 2005, at 18:32:34

In reply to Re: MAOIs and psycho-surgery, posted by linkadge on November 22, 2005, at 15:53:52

> I can understand how the cumulative side effect profile can make life miserable in itself, especially when the drug isn't doing what it should.
>
> But for goodness sakes if an MAOI works then take it. You'll never really be able to ballance the positives/negatives unless you try and see.
>
> I found that parnate had no side effects as compared to the SSRI's. And geez giving up a few foods was not a big deal, I very quickly learned to find foods I enjoyed that were allowable.
>
> Severe depression is life threatening in my books. Avoiding sardenes is not.
>
>
>
>
>
> Linkadge
>
>


I agree with you totally, and I'm not ruling MAOIs out. But again, I've had such a horrific history with meds that I'm a little skittish. Especially since those things need two week washout periods before and after. I don't know if I could actually handle that if I ended up having to be on nothing. Interestingly, it seems that my doctor is not ready to turn to the MAOIs yet because of all the hassle with diet and med interactions. I wonder if he had a patient who made a mistake? He's not ruling them out though.

 

Re: MAOIs

Posted by linkadge on November 23, 2005, at 15:53:19

In reply to Re: MAOIs linkadge, posted by Bob on November 22, 2005, at 18:29:00

The idea that antidepressants work via alteration in sleep stages is not a proposition of my own.

Doctors knew that depression could be treated by either total sleep deprivation or REM sleep interuption. SSRIs reduce REM sleep, as do the MAOI's. Antidepressant withdrawl can cause a REM rebound and subsequenct cholinergic rebound and depression.

I found it interesting that the MAOI's reduced REM much more than did the SSRI's. The MAOI's are often more clinically effective drugs.

Reducing rem sleep is often sufficiant to produce antidepressant responce.

I first was under the impression that antidepressants normalized rem sleep, but some literature seems to suggest that AD's can suppress it much lower than baseline.


Linakadge

 

Re: MAOIs linkadge

Posted by Bob on November 24, 2005, at 0:01:07

In reply to Re: MAOIs, posted by linkadge on November 23, 2005, at 15:53:19

> The idea that antidepressants work via alteration in sleep stages is not a proposition of my own.
>
> Doctors knew that depression could be treated by either total sleep deprivation or REM sleep interuption. SSRIs reduce REM sleep, as do the MAOI's. Antidepressant withdrawl can cause a REM rebound and subsequenct cholinergic rebound and depression.
>
> I found it interesting that the MAOI's reduced REM much more than did the SSRI's. The MAOI's are often more clinically effective drugs.
>
> Reducing rem sleep is often sufficiant to produce antidepressant responce.
>
> I first was under the impression that antidepressants normalized rem sleep, but some literature seems to suggest that AD's can suppress it much lower than baseline.
>
>
> Linakadge
>
>
>
>

I definitely have trouble with SSRI withdrawl. If MAOIs reduce REM sleep to a much greater degree than SSRIs, would it follow that withdrawal with the former is more troublesome than with SSRIs?

 

Re: MAOIs Bob

Posted by Jedi on November 24, 2005, at 2:58:33

In reply to Re: MAOIs linkadge, posted by Bob on November 24, 2005, at 0:01:07

> I definitely have trouble with SSRI withdrawl. If MAOIs reduce REM sleep to a much greater degree than SSRIs, would it follow that withdrawal with the former is more troublesome than with SSRIs?

Bob,
Abrupt withdrawal of the MAOIs is said to cause vivid dreams and nightmares. This would be logical since REM sleep is reduced while taking the MAOI.

I've always tapered Nardil when I've come off, and had no problems like this. That is until the major depression reoccurred after each withdrawal. After two of these relapses, I realized I will be on Nardil for life. Or at least until the miracle drug is cooked.

I do understand your plight on this med thing. I've been on more than 25 different combinations trying to find something that works without the side effects. In my experience, nothing is perfect. I found something that keeps me out of bed for 16 hours a day and lets me function, albeit at a level less than my former self. IMHO, you are focusing more on side effects and withdrawal than on finding the medication that will work. I do empathize because I've been there. Focus on finding the med that works best, stay on it, and augment for side effects.

Do you use Omega-3s? For a supplement, I've found that about 3 grams a day does help my depression. With our western diet consisting of very small amounts of Omega-3 fatty acids, I believe they can help a lot of people with their depression, plus you get the heart benefits. More on this later.
Get Well Soon,
Jedi

 

Re: MAOIs

Posted by linkadge on November 25, 2005, at 19:09:46

In reply to Re: MAOIs linkadge, posted by Bob on November 24, 2005, at 0:01:07

I found MAOI withdrawl was much harder than SSRI withdrawl. I went extrordinarily tweekey coming off parnate. The rem rebound must have been significant.

Significant REM rebound can cause psychotic behavior. I wen't totally loopy for a while.


Linkadge

 

Re: MAOIs Jedi

Posted by Bob on November 26, 2005, at 0:20:17

In reply to Re: MAOIs Bob, posted by Jedi on November 24, 2005, at 2:58:33

> > I definitely have trouble with SSRI withdrawl. If MAOIs reduce REM sleep to a much greater degree than SSRIs, would it follow that withdrawal with the former is more troublesome than with SSRIs?
>
> Bob,
> Abrupt withdrawal of the MAOIs is said to cause vivid dreams and nightmares. This would be logical since REM sleep is reduced while taking the MAOI.
>
> I've always tapered Nardil when I've come off, and had no problems like this. That is until the major depression reoccurred after each withdrawal. After two of these relapses, I realized I will be on Nardil for life. Or at least until the miracle drug is cooked.
>
> I do understand your plight on this med thing. I've been on more than 25 different combinations trying to find something that works without the side effects. In my experience, nothing is perfect. I found something that keeps me out of bed for 16 hours a day and lets me function, albeit at a level less than my former self. IMHO, you are focusing more on side effects and withdrawal than on finding the medication that will work. I do empathize because I've been there. Focus on finding the med that works best, stay on it, and augment for side effects.
>
> Do you use Omega-3s? For a supplement, I've found that about 3 grams a day does help my depression. With our western diet consisting of very small amounts of Omega-3 fatty acids, I believe they can help a lot of people with their depression, plus you get the heart benefits. More on this later.
> Get Well Soon,
> Jedi
>

I did try Omega-3 capsules years back. I honestly think there's very little I haven't tried. Anyway, they didn't seem to do much except make my belches smell like fish. So, I increased the dose quite a bit. It seemed like if anything, they made me a little anxious. I eventually stopped them. Maybe I'll revisit them at some point. Your theory about the deficit of Omega-3 in the West is a sound one. That's what is so frustrating sometimes - all these meds and augmentation strategies are so good on paper.

 

Re: MAOIs linkadge

Posted by Bob on November 26, 2005, at 0:22:09

In reply to Re: MAOIs, posted by linkadge on November 25, 2005, at 19:09:46

> I found MAOI withdrawl was much harder than SSRI withdrawl. I went extrordinarily tweekey coming off parnate. The rem rebound must have been significant.
>
> Significant REM rebound can cause psychotic behavior. I wen't totally loopy for a while.
>
>
> Linkadge
>
>

You're saying that your withdrawal from the MAOI actual made you psychotic? Now that's scary! That really, really sucks. What types of symptoms did you have?

 

Re: When the options are gone?

Posted by Peace2U on November 26, 2005, at 1:14:40

In reply to When the options are gone?, posted by Bob on November 17, 2005, at 16:31:29

Hi Bob,

I did not have an opportunity to read all the subsequent posts but would like to add my 2 cents to the MAOI debate.

I was fortunate to find a psychiatrist at a major university in 1982 who started me on Parnate and klonopin. After 10 years of major depression and those awful tricyclics, I never felt more alive. After my Doc left for another position in a different city, I had a difficult time finding another psychiatrist who would presecribe an MAOI. This was during the 'revolutionary' era of Prozac and other SSRIs. After trying Wellbutrin. Prozac, Zoloft, et al, I would finally get a script for Parnate. As new meds came out I was taken off Parnate and given Remeron, Serzone, Paxil, Celexa, Lexapro, Effexor etc with poor results. Too many doctors have a fear of MAOIs and don't think the patient can read or follow instructions to avoid certain foods/meds.

I did not find the diet restrictions difficult to adhere to and they are not as complicated as people think. I lost a lot of weight which I think was a combination of feeling good and not being allowed to eat pounds of cheese a day (I love pizza)! The doc also gave me a script for Thorazine "just in case." But I could follow the diet and never needed to use them. I also wore a med alert bracelet in case of emergency so no ER doc would accidently give me a shot of Demerol.

I also found I had more energy and the only side effect I had was orthostatic hypotension. I felt that was a small price to pay to have relief from the debilitating depression. I had no problems weaning off Parnate and it took only a short period of time. I have been off ADs for over two years and although I am struggling, I am hoping the selegeline (sp?) patch will be available soon if I need to go back on. For whatever reason the Parnate no longer is effective for me. May be chemical changes or postmenopausal stuff, who knows.

This has been my experience and I am so grateful for the good years I did have (not that they are over). I do know how hopeless you are feeling and I just wanted to share my experience with you so you might give MAOIs some consideration. I have never had ECT so I think your depression is more severe than mine. It is hard to know, we are all different.

I just did not want fear to stop you from trying something that may be of benefit for you. Now, ECT scares the hell out of me. Oh, one more thing. I felt better within two weeks of starting the Parnate.

Take care of yourself and be well. Whatever you decide to do, I wish you the best.

Peace

 

Re: When the options are gone? Peace2U

Posted by Bob on November 26, 2005, at 1:55:54

In reply to Re: When the options are gone?, posted by Peace2U on November 26, 2005, at 1:14:40

> Hi Bob,
>
> I did not have an opportunity to read all the subsequent posts but would like to add my 2 cents to the MAOI debate.
>
> I was fortunate to find a psychiatrist at a major university in 1982 who started me on Parnate and klonopin. After 10 years of major depression and those awful tricyclics, I never felt more alive. After my Doc left for another position in a different city, I had a difficult time finding another psychiatrist who would presecribe an MAOI. This was during the 'revolutionary' era of Prozac and other SSRIs. After trying Wellbutrin. Prozac, Zoloft, et al, I would finally get a script for Parnate. As new meds came out I was taken off Parnate and given Remeron, Serzone, Paxil, Celexa, Lexapro, Effexor etc with poor results. Too many doctors have a fear of MAOIs and don't think the patient can read or follow instructions to avoid certain foods/meds.
>
> I did not find the diet restrictions difficult to adhere to and they are not as complicated as people think. I lost a lot of weight which I think was a combination of feeling good and not being allowed to eat pounds of cheese a day (I love pizza)! The doc also gave me a script for Thorazine "just in case." But I could follow the diet and never needed to use them. I also wore a med alert bracelet in case of emergency so no ER doc would accidently give me a shot of Demerol.
>
> I also found I had more energy and the only side effect I had was orthostatic hypotension. I felt that was a small price to pay to have relief from the debilitating depression. I had no problems weaning off Parnate and it took only a short period of time. I have been off ADs for over two years and although I am struggling, I am hoping the selegeline (sp?) patch will be available soon if I need to go back on. For whatever reason the Parnate no longer is effective for me. May be chemical changes or postmenopausal stuff, who knows.
>
> This has been my experience and I am so grateful for the good years I did have (not that they are over). I do know how hopeless you are feeling and I just wanted to share my experience with you so you might give MAOIs some consideration. I have never had ECT so I think your depression is more severe than mine. It is hard to know, we are all different.
>
> I just did not want fear to stop you from trying something that may be of benefit for you. Now, ECT scares the hell out of me. Oh, one more thing. I felt better within two weeks of starting the Parnate.
>
> Take care of yourself and be well. Whatever you decide to do, I wish you the best.
>
> Peace

Thank you very much for that post. It was very helpful. I am quite sorry to hear that the Parnate stopped working for you. I agree with you about the MAOI prescriptions. I think that once the SSRIs came along, MAOIs were definitely relegated to a last resort, one which many doctors seem not willing to take. Not only that, few drug companies seem to be looking at that avenue for drug development - just an endless line of serotonin drugs.

As for ECT, they claim that ECT works great for most people. I wasn't one of them. Just as you said, though, we're all different. I can tell you that ECT doesn't just affect serotonin, so you'd think the drug companies would start looking further. I don't know if you have spent two years on now drugs at all, but if you have, that is about 1 year, 11 months, 3 weeks, and some undetermined number of days longer than I'd last.

 

Re: When the options are gone? Peace2U

Posted by Bob on November 26, 2005, at 2:18:43

In reply to Re: When the options are gone?, posted by Peace2U on November 26, 2005, at 1:14:40


> I was fortunate to find a psychiatrist at a major university in 1982 who started me on Parnate and klonopin. After 10 years of major depression and those awful tricyclics, I never felt more alive.

So I gather that you found Parnate to be significantly more tolerable than the Tricyclics? Interesting, as I was under the impression that the tolerability between the two classes was not all that different. MAOIs do have anticholinergic effects, right?

 

Re: When the options are gone? Bob

Posted by ed_uk on November 26, 2005, at 13:31:57

In reply to Re: When the options are gone? Peace2U, posted by Bob on November 26, 2005, at 2:18:43

Hi Bob

The MAOIs are not anticholinergic as such: unlike the tricyclics they do not block cholinergic receptors directly. They do often cause side effects which resemble anticholinergic symptoms though, probably because of their noradrenergic properties.

>Interesting, as I was under the impression that the tolerability between the two classes was not all that different.

The MAOIs and tricyclics are very different. Because of this, some people have more side effects on tricyclics whereas other people have more side effects on MAOIs. Your experience with tricyclics cannot be used to predict whether you will have side effects from MAOIs. In addition, Nardil is quite different to Parnate. People often report that they find them very different, both in terms of therapeutic effects and side effects.

Kind regards

Ed


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