![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 61 to 85 of 85. Go back in thread:
Posted by ed_uk on May 10, 2006, at 10:01:59
In reply to Re: MAOIs » ed_uk, posted by yxibow on May 9, 2006, at 17:25:47
>I have no idea if you were feeling better, feeling better because of euphoria, or feeling euphoric
Not sure what that's supposed to mean. Are you saying that if a med makes someone feel better this is a form of euphoria?
>intended purpose
And who is to say what a drug's intended purpose should be? Some people believe that atypical APs should never be used to treat insomnia.......other people believe that using APs to treat insomnia is perfectly acceptable. It's all a matter of opinion.
>divert OTC medications
It seems that you're referring to the diversion of OTC meds after using them to synthesize other drugs. I was thinking more of diversion of drugs in their original state.
>Catatonic" "Vast majority." That means "most all people." I just said it!
I wouldn't say most people with schizophrenia are catatonic. Most people with schizophrenia suffer from delusions, hallucinations and disorganised behaviour. Catatonia is present in some but not the vast majority.
>only Canada and the UK have caps
That's not true at all. Many countries have price controls. Certainly, most European countries do.
>I wouldn't want a end-all happy pill for antidepression that cost only $1 million to produce to come to market. That would scare me and suggest that they tested it on like 2 patients.
Well no, but for widely prescribed drugs like APs pharmaceutical companies do not need to charge such high prices to regain the money they spent on research. They quickly end up making huge profits.
>Go petition the FDA, but you're not likely to get anywhere.
Nah, I won't bother thanks.
Ed
Posted by ed_uk on May 10, 2006, at 10:07:33
In reply to Re: MAOIs and everything else » Phillipa, posted by yxibow on May 9, 2006, at 23:31:54
>Ed has been a bit obsessive about my views
Perhaps, it's in my nature to be obsessive.
>I don't believe that it should have been diverted for euphoria in the US because now we can't take it over the counter for cough medication in the US like we used to
I don't believe my having taken codeine has affected your ability to obtain it Yxi.
Ed
Posted by ed_uk on May 10, 2006, at 10:10:14
In reply to Re: MAOIs » ed_uk, posted by Don_Bristol on May 10, 2006, at 9:35:55
Hi Don
>Yes I take Parnate. And very good it is too.
Did you tell your pdoc what I said about the maximum dose not being 30mg?
Ed
Posted by Don_Bristol on May 10, 2006, at 10:10:32
In reply to Re: MAOIs, posted by Jost on May 9, 2006, at 23:27:19
> > Hi Don,
> >
> > The figures you quoted, were they from http://www.emedicine.com/EMERG/topic318.htm ? You posted a link to the aapcc's website, but I honestly couldn't make heads or tails of anything on it.
> >
>
>
> The figures Don quoted, unless I'm mistaken (which I might be) were from a "Summary of fatal exposures reported to TESS in 2002" published in the Am J. of Emergency Med.
>
> However, the Summary, as I read it, noted only one death from an maoi, ie parnate; and the cause of death was "ther. err."--ie therapist error, rather than an adverse drug reaction.
>
> Possibly, Don's statistics are from another source. However, the type of AD associated with the highest number of fatalities on this report, by far, was tricyclics, particularly. amitriptyline. Is this the most widely prescribed tricylic?
>
> Most of the deaths were intentional. There are a few other causes, such as "malicious," "adv. react." and "ther. err." The number of adverse reactions is so small that it would seem hard to draw any conclusions from this one report.
>
> Last night I came across a paper--I can't find it now--that suggested that deaths from tricyclics were greater in absolute numbers than those from maois, although a somewhat greater proportion of the maoi fatalities were intentional. The difference didn't seem so great as to make the argument that maois are to be avoided at all costs. Obviously, care must be taken in their use..
>
> I'd be interested in Don's sources, though.
>
> Jost
>
>--------------------
Hi Jost
This is the document in PDF form
<http://www.aapcc.org/Annual%20Reports/02report/AnnlRpt02Table22.pdf>;
Go to page 404 (PDF doc page 12).
Read the line across for MAOIs. Last figures shows 2 deaths, 26 major and 81 moderate. I put it into a spreadsheet. http://tinyurl.com/ppmd5 Let me know if the percentages are wrong because I did for my own use and approximate figures were good enough for what I needed. The breakdown by type occurs there which is why I said about a third were intentional (81 out of 181 intentional plus the 81 intentional) because the data is patchy and the categories overlap so UNintentional + Intentional + unknowns will equal the total population sampled.
That is what I was quoting. I used those 2003 figures in June 2004 because they were the lastest available. Now newer figures are available and you can compile them (save me the trouble!) from http://www.aapcc.org/annual.htm then "View Report By Sections" then "Table 22A-22B".
Not sure where you got your data about "ther. err." and that sort of breakdown. Do you have a link?
Was it you who posted this to this thread?: "However the chance of a stroke and unilateral or bilateral neurological damage is higher. Its worse than death. Its immobilization and life debilitating."
In a funny way I really do agree. When you're dead, you're dead. But to live with severe brain damage is a living death and is an even more frightening prospect to me than death.
rgds, Don
Posted by ed_uk on May 10, 2006, at 10:17:37
In reply to Re: MAOIs » Jost, posted by Don_Bristol on May 10, 2006, at 10:10:32
>But to live with severe brain damage is a living death and is an even more frightening prospect to me than death.
I agree. I hope you weren't offended by my last post to you. MAOIs can be frightening. Do you carry a nifedipine capsule yourself?
Ed
Posted by ed_uk on May 10, 2006, at 10:19:21
In reply to Re: MAOIs and everything else » Phillipa, posted by yxibow on May 9, 2006, at 23:49:45
Hi J
Please reply in private if you wish. I don't want to talk on the board anymore. Thank you.
Regards
Ed
Posted by yxibow on May 10, 2006, at 12:38:18
In reply to Re: MAOIs and everything else » yxibow, posted by ed_uk on May 10, 2006, at 10:19:21
> Hi J
>
> Please reply in private if you wish. I don't want to talk on the board anymore. Thank you.
>
> Regards
>
> Ed
>Good idea, I just did. And let's all be civil -- actually I think I have been fairly so.
Evening, sweetness.
Posted by Don_Bristol on May 10, 2006, at 14:34:30
In reply to Re: MAOIs » Don_Bristol, posted by ed_uk on May 10, 2006, at 10:17:37
> But to live with severe brain damage is a
> living death and is an even more frightening
> prospect to me than death.
>
> I agree. I hope you weren't offended by my last
> post to you. MAOIs can be frightening. Do you
> carry a nifedipine capsule yourself?
>
> Ed------------
You have given no offense at all. Not even faintly.
AIUI, Nifedapine is contra-indicated for a hypertensive crisis.
"The Dangers of Immediate-Release Nifedipine for Hypertensive Crises"
<http://www.ptcommunity.com/ptjournal/fulltext/27/7/PTJ2707362.pdf>;"Alternatives to Nifedipine in the Oral Treatment of Hypertensive Urgencies"
<http://www.rxfiles.ca/acrobat/nifed-hu.pdf>;I used to carry Captopril but now I don't usually bother.
best wishes
Don
Posted by gardenergirl on May 10, 2006, at 15:48:04
In reply to Re: MAOIs » ed_uk, posted by Don_Bristol on May 10, 2006, at 14:34:30
My pdoc did not give me nifidepine. I do wear a medical alert bracelet which states I take an MAOI, and cautions about food and drug interactions. It also points out the risk of hypertensive crisis. I am hopeful that in the unlikely and unfortunate event that I am in an ER unconscious, someone will use this to make informed diagnosis and treatment decisions.
gg
Posted by Phillipa on May 10, 2006, at 18:28:04
In reply to Re: MAOIs, posted by gardenergirl on May 10, 2006, at 15:48:04
GG I don't want to sound negative but I certainly hope they know what an MAOI is. Most ER personal know nothing about psych meds. Sad but true. Please someone tell me I'm wrong. Love Phillipa
Posted by ed_uk on May 10, 2006, at 18:41:27
In reply to Re: MAOIs » ed_uk, posted by Don_Bristol on May 10, 2006, at 14:34:30
Hi Don
>Nifedapine is contra-indicated for a hypertensive crisis
I think we discussed this once before, do you rememeber? And captopril too. I remember you posting some links.
Some psychiatrists consider nifedipine to be an appropriate treatment for an MAOI hypertensive crisis. The dose should be low, and the patient should still go to hospital.
As you rightly point out, immediate-release nifedipine is not suitable for most types of hypertensive crisis. Many (non-MAOI) hypertensive crises occur in people with chronic hypertension and cardiovascular disease. Immediate-release nifedipine should not be prescribed to these patients. This does not mean that immediate-release nifedipine is contra-indicated in MAOI crises however, which occur in very different circumstances, in different types of patients, who do not, in general, suffer from chronic cardiovascular disease.
Regards
Ed
Posted by ed_uk on May 10, 2006, at 18:42:33
In reply to Re: MAOIs » gardenergirl, posted by Phillipa on May 10, 2006, at 18:28:04
One would hope that the medic-alert bracelet provides enough info :S
Ed
Posted by Jost on May 10, 2006, at 19:10:38
In reply to Re: MAOIs » Phillipa, posted by ed_uk on May 10, 2006, at 18:42:33
> One would hope that the medic-alert bracelet provides enough info :S
>
> EdAlso that medical personnel would have the sense,if you have a bracelet, and they don't recognize the medication, to check the PDR.
It might be extra protection to carry a card in your wallet that repeats the information, and has the name or phone number of your psych doctor. That's what I did, anyway.
Jost
Posted by Phillipa on May 10, 2006, at 19:22:33
In reply to Re: MAOIs, posted by Jost on May 10, 2006, at 19:10:38
Excellent idea gg what does the bracelet say? Maybe if it doesn't your Doc's name and phone number should be included. Love Phillipa
Posted by gardenergirl on May 10, 2006, at 22:19:25
In reply to Re: MAOIs, posted by Jost on May 10, 2006, at 19:10:38
> > One would hope that the medic-alert bracelet provides enough info :S
> >
> > Ed
>
> Also that medical personnel would have the sense,if you have a bracelet, and they don't recognize the medication, to check the PDR.Yep.
>
> It might be extra protection to carry a card in your wallet that repeats the information, and has the name or phone number of your psych doctor. That's what I did, anyway.I have that, too. Plus an article about MAOI's on my Palm, so if I'm coherent, I can show them.
gg
Posted by Phillipa on May 10, 2006, at 22:22:23
In reply to Re: MAOIs » Jost, posted by gardenergirl on May 10, 2006, at 22:19:25
gg what if you are not? Love Phillipa
Posted by gardenergirl on May 10, 2006, at 22:23:47
In reply to Re: MAOIs » Jost, posted by Phillipa on May 10, 2006, at 19:22:33
> Excellent idea gg what does the bracelet say? Maybe if it doesn't your Doc's name and phone number should be included. Love Phillipa
The front has:
My name
Takes MAOI
No Demerol
See backThe back says:
Warning:
Drug and food interactions
Anesthesia cautions (guess that's a line that's not needed)
Hypertensive crisis riskI'm not planning to get a new one anytime soon, as this one cost $65. I opted for gold since I wear it all the time, and most of my jewelry is gold. I figure that is enough information to make a reasonable person be cautious and get more information if they don't understand. Hopefully, it will never be needed, but I feel better wearing it.
gg
Posted by Phillipa on May 10, 2006, at 23:23:50
In reply to Medic alert bracelet information » Phillipa, posted by gardenergirl on May 10, 2006, at 22:23:47
That sounds good to me. Someone would have to be in zombie land not to look into that. Thanks for telling me . I had no ideas what the bracelets say and I'd opt for gold too. Love Phillipa
Posted by yxibow on May 11, 2006, at 2:36:56
In reply to Re: Medic alert bracelet information » gardenergirl, posted by Phillipa on May 10, 2006, at 23:23:50
I carry a credit card sized printed medical alert on card stock with the entire list of my current medications and their doses in my wallet prominantly visible with a medical symbol under my drivers license, as well as my doctor's name, address, and all his contacts for the unforseen circumstances. I update this as it changes.
I think it is a good thing for peace of mind for people especially who take polypharmacy.
-- tidings
Jay
Posted by Don_Bristol on May 11, 2006, at 7:58:13
In reply to Re: MAOIs » Don_Bristol, posted by ed_uk on May 10, 2006, at 18:41:27
Don wrote
>
>Nifedapine is contra-indicated for a hypertensive crisis
>Ed UK wrote
>
> I think we discussed this once before, do you rememeber?
> And captopril too. I remember you posting some links.
>
Hey! Have you been here as long as all that? *grin*
It was something like two years ago.
I like Bob's Psychobabble but the message go slashing by so quickly into the archives that I found it was getting a hard job keeping up with what was being said. It kind of gets to be too obsessional for me and that's the last thing I need!>
> Some psychiatrists consider nifedipine to be an appropriate treatment
> for an MAOI hypertensive crisis. The dose should be low, and the
> patient should still go to hospital.
>I guess that a lot of medicine is an art and so I am sure there are a spectrum of views. I don't have a need to support nifedinine for captopril or whatever. I started by not know what the heck to take and just did some reading. The documents I linked to in oneof my postings here were some I came across and which I judged, as afr as I could tell (which wasn't a great deal!) seemed to be reasonably sound.
>
> As you rightly point out, immediate-release nifedipine is not
> suitable for most types of hypertensive crisis. Many (non-MAOI)
> hypertensive crises occur in people with chronic hypertensionUh oh! That's definitely me! :-(
> and cardiovascular disease. Immediate-release nifedipine should
> not be prescribed to these patients. This does not mean that
> immediate-release nifedipine is contra-indicated in MAOI crises
> however, which occur in very different circumstances, in different
> types of patients, who do not, in general, suffer from chronic
> cardiovascular disease.Well, I went for Captopril but I have never had to use it. I do recall readng posters here who did have to use their nifedipine. There was a very good account here by someone a couple of years ago on how the writer had taken nifedipine and understood the need to keep calm as he made his way to the ER (A&E to you and me in the UK ). ISTR that nifedipine was sedating (or was it another med he augemnted it with) and that that was a help in staying calm too.
I am still not too sure how I could tell a hypertensive crisis until it was too late and I got the mother and father of headaches in the back of my head. I used to think I would carry a small wrist based blood pressure monitor to help me know but in the end I stopped carrying it. The wrist ones are said not to be accurate despite all the many reassurances from manufacturers and indeed I found that the international blood pressure machine tests had found that. However I figured that 10 units either way was not going to matter as hypertension is pretty dramatic. But the resident Prof Grim http://www.ishib.org/AI_board_cgrim.asp at Yahoo group Bloodpressureline told me not to chance anything because I could be playing a stupid game of "berry aneurysm roulette". I figured he should know as he does stuff like being the director of a high blood pressure treatment center and has a special interest in blood pressure.
BTW can you say anything about which doc in the UK is prescribing you MAOIs? The one which started me was the consultant p-doc Doc Wildgrube who had come over from Germany and was working for the NHS in London. I suspect the Germans might use MAOIs more than the UK because every other doc has been wary. What about your MAOI doc? Email me if you prefer.
rgds Don
Posted by ed_uk on May 11, 2006, at 15:32:06
In reply to Re: MAOIs » ed_uk, posted by Don_Bristol on May 11, 2006, at 7:58:13
Hi Don
>Have you been here as long as all that?
I've been here a while :)
>I guess that a lot of medicine is an art and so I am sure there are a spectrum of views.
Definitely.
>Uh oh!
You suffer from essential hypertension? What meds do you take for your blood pressure? I wasn't saying that chronic hypertension increases the risk of an MAOI causing a hypertensive crisis - there is no evidence of this. Controlled-release nifedipine (eg. Adalat LA) is often very useful in the treatment of chronic hypertension. Immediate-release nifedipine caps are not suitable for treating chronic hypertension.
>nifedipine was sedating
Nifedipine is not generally sedating. Perhaps he took some chlorpromazine or diazepam.
>I am still not too sure how I could tell a hypertensive crisis until it was too late
An MAOI-hypertensive crisis is characterised by the *abrupt* onset of symptoms such as a severe headache and neck stiffness. Symptoms occur because the rise in BP is very rapid. Chronic hypertension (eg. essential hypertension) does not cause symptoms.
An MAOI-induced hypertensive crisis should be treated rapidly. If nifedipine is used, the initial dose should be low: 5mg - a starting dose which is considered relatively safe in the UK. High initial doses can be risky. A 5mg immediate-release capsule can be chewed and swallowed. The capsules contain a viscous yellow fluid. The fluid should be swallowed (there is no reason to retain it in the mouth - as some have suggested). The dose may be repeated after 30 minutes if necessary - but only if BP is still very high. Medical advice should be obtained ASAP. Blood pressure should be measured using a cuff around the upper arm. Diazepam 10mg can be taken immediately for anxiety. Chlorpromazine 20-25mg may also be useful - both for anxiety and BP. The problem with captopril is that although it is effective against many types of hypertension, there is no evidence that it can treat an MAOI-tyramine crisis.
>Can you say anything about which doc in the UK is prescribing you MAOIs?
I've only taken moclobemide myself! Currently, I take citalopram 80mg in the morning and amitriptyline 10mg at night.
Regards
Ed
Posted by Donna Louise on May 12, 2006, at 6:28:27
In reply to Re: MAOIs, posted by yxibow on May 4, 2006, at 20:18:27
> > >I'm talking about people with severe sinusits
> >
> > OK, but how is this relevent? The vast majority of patients who are considering taking an MAOI do not suffer from sinusitis.
>
> Is there a study ? One will never know. There are few other things that will control it other than saline or steroidal use which is always an iffy thing even if nasal steroids are relatively harmless, they can still cause HPA axis issues and that is nothing good to add to severe depression.
>
> >
> > >ECT is a controlled seizure.
> >
> > That would be a euphemism. Potent muscle relaxants are necessary during ECT to prevent violent convulsions. People used to break their back during ECT, the convulsions were so severe. I think this gives you a good idea of what sort of seizure is being induced.
>
> No, its not a euphemism, its exactly what it is according to my doctor who has I think two decades more experience than myself as an MD. I didn't say it was something to take lightly... I wouldnt go there any more than I would an MAOI.
>
>
> > >Actually the FAQ on the link with the ECT machine you showed points out the positive benefits that I aforementioned in the other reply and the rarity of severe complications.
> >
> > Well of course! Manufacturers of ECT machines will inevitably downplay the risks!
>
> So why post it, I was lost ?
>
>
> > >And suppose you've been hit by a car? I'd highly suggest a medical wristband that says MAOI.
> >
> > Indeed, such wristbands can be obtained easily, and cheaply. Only a minority of drugs used in emergency medicine need to be avoided - Demerol being the obvious example. Epinephrine is not contra-indicated.
>
> Good, we agree here.
>
>
>
> > Let's compare: mild cough versus severe untreated mental illness. Which is most likely to lead to people needing to take time off work? Given dextromethorphan's minimal effectiveness, it is not likely to help someone go to work. Simple linctus would do just as well.
>
> Mm... ask the millions of Americans who use it daily. I agree, its not a great drug. Its not terribly powerful. In fact its quite weak, deliberately so, almost punitively, to discourage abuse which does still exist (yuck).
>
>
> > >Hmm... I seem to remember you using OTC codeine :)
> >
> > Yep, I took it because it makes me feel better, not to treat a cough.
>
> Hmm.. I won't go there because that's character assasination.
>I am just now reading this thread as I have been busy with the patch threads and Life for a change. I have been wanting to get an ID bracelet, where is one obtained cheaply and easily? And I just have to comment, about the DXM and how it can get one through work with a cough or whatever it treats, that does presuppose one would be mentally well enough to go to work in the first place. I would have to cross the snotty nose bridge when I got there. Perhaps I should stay home from work anyway so as not to spread germs, assuming I would employable in the first place that is.
Donna
Posted by yxibow on May 13, 2006, at 0:10:48
In reply to Re: MAOIs » yxibow, posted by Donna Louise on May 12, 2006, at 6:28:27
> > > >I'm talking about people with severe sinusits
> > >
> > > OK, but how is this relevent? The vast majority of patients who are considering taking an MAOI do not suffer from sinusitis.
> >
> > Is there a study ? One will never know. There are few other things that will control it other than saline or steroidal use which is always an iffy thing even if nasal steroids are relatively harmless, they can still cause HPA axis issues and that is nothing good to add to severe depression.
> >
> > >
> > > >ECT is a controlled seizure.
> > >
> > > That would be a euphemism. Potent muscle relaxants are necessary during ECT to prevent violent convulsions. People used to break their back during ECT, the convulsions were so severe. I think this gives you a good idea of what sort of seizure is being induced.
> >
> > No, its not a euphemism, its exactly what it is according to my doctor who has I think two decades more experience than myself as an MD. I didn't say it was something to take lightly... I wouldnt go there any more than I would an MAOI.
> >
> >
> > > >Actually the FAQ on the link with the ECT machine you showed points out the positive benefits that I aforementioned in the other reply and the rarity of severe complications.
> > >
> > > Well of course! Manufacturers of ECT machines will inevitably downplay the risks!
> >
> > So why post it, I was lost ?
> >
> >
> > > >And suppose you've been hit by a car? I'd highly suggest a medical wristband that says MAOI.
> > >
> > > Indeed, such wristbands can be obtained easily, and cheaply. Only a minority of drugs used in emergency medicine need to be avoided - Demerol being the obvious example. Epinephrine is not contra-indicated.
> >
> > Good, we agree here.
> >
> >
> >
> > > Let's compare: mild cough versus severe untreated mental illness. Which is most likely to lead to people needing to take time off work? Given dextromethorphan's minimal effectiveness, it is not likely to help someone go to work. Simple linctus would do just as well.
> >
> > Mm... ask the millions of Americans who use it daily. I agree, its not a great drug. Its not terribly powerful. In fact its quite weak, deliberately so, almost punitively, to discourage abuse which does still exist (yuck).
> >
> >
> > > >Hmm... I seem to remember you using OTC codeine :)
> > >
> > > Yep, I took it because it makes me feel better, not to treat a cough.
> >
> > Hmm.. I won't go there because that's character assasination.
> >
>
> I am just now reading this thread as I have been busy with the patch threads and Life for a change. I have been wanting to get an ID bracelet, where is one obtained cheaply and easily? And I just have to comment, about the DXM and how it can get one through work with a cough or whatever it treats, that does presuppose one would be mentally well enough to go to work in the first place. I would have to cross the snotty nose bridge when I got there. Perhaps I should stay home from work anyway so as not to spread germs, assuming I would employable in the first place that is.
Oh I agree -- but the US work force doesn't like to give out very many sick days. Hence everyone in the office gets the cold or the flu. I agree in an ideal world one should stay home and isolate their sickness. Not that it is terribly effective, but I believe it is proper in Japanese cultures to wear a mask if one is ill. I'm not sure. I've seen it before though.ID bracelets can be ordered online, I'm not familiar with them since I just print my own ID card in my wallet, I dont have a more pressing need which I would agree with those on high dose MAOIs. So I would search around with Froogle for a site -- maybe someone can comment on it. And of course be sure the place looks legit and not overcharging.
Posted by gardenergirl on May 13, 2006, at 11:18:19
In reply to MAOIs, DXM, illness in the workforce and bracelets » Donna Louise, posted by yxibow on May 13, 2006, at 0:10:48
I got my bracelet from here:
http://www.americanmedical-id.com/home/
gg
Posted by Donna Louise on May 14, 2006, at 7:44:34
In reply to bracelet resource, posted by gardenergirl on May 13, 2006, at 11:18:19
This is the end of the thread.
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