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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 19 of 19. This is the beginning of the thread.
Posted by JaclinHyde on May 20, 2006, at 11:30:52
Here are two interesting facts concerning MAOI's
"However, it has been estimated that, of the 3.5 million patients that had used tranylcypromine (Parnate) by 1970, about 50 persons reportedly had cerebrovascular accidents and 15 of these individuals died (58)."
"Both the irreversible MAOIs and the RIMAs rarely cause cardiac effects and at therapeutic doses have little effect on seizure threshold. Hepatotoxicity (e.g., progressive, necrotizing, hepatocellular damage) has occurred in some patients receiving MAOIs of the hydrazine type (e.g., phenelzine/Nardil) making it advisable to check liver function periodically in patients receiving high doses and in those receiving prolonged therapy with these drugs. Risk of hepatotoxicity with the non-hydrazine MAOIs (e.g., tranylcypromine/Parnate, pargyline, selegiline) and the RIMAs (e.g., moclobemide, brofaromine) is absent or minimal."
JH
Posted by Phillipa on May 20, 2006, at 11:46:32
In reply to Interesting MAOI's info, posted by JaclinHyde on May 20, 2006, at 11:30:52
So do you think that's really why the docs stopped using them? Love Phillipa
Posted by JaclinHyde on May 20, 2006, at 12:28:53
In reply to Re: Interesting MAOI's info » JaclinHyde, posted by Phillipa on May 20, 2006, at 11:46:32
What's really why?
JH
> So do you think that's really why the docs stopped using them? Love Phillipa
Posted by Caedmon on May 20, 2006, at 13:12:11
In reply to Interesting MAOI's info, posted by JaclinHyde on May 20, 2006, at 11:30:52
> "Both the irreversible MAOIs and the RIMAs rarely cause cardiac effects and at therapeutic doses have little effect on seizure threshold. Hepatotoxicity (e.g., progressive, necrotizing, hepatocellular damage) has occurred in some patients receiving MAOIs of the hydrazine type (e.g., phenelzine/Nardil) making it advisable to check liver function periodically in patients receiving high doses and in those receiving prolonged therapy with these drugs. Risk of hepatotoxicity with the non-hydrazine MAOIs (e.g., tranylcypromine/Parnate, pargyline, selegiline) and the RIMAs (e.g., moclobemide, brofaromine) is absent or minimal."
>Interesting! BTW, do you happen to know the source? (It was a quotation after all.)
- Chris
Posted by JaclinHyde on May 20, 2006, at 17:36:44
In reply to Re: Interesting MAOI's info » JaclinHyde, posted by Caedmon on May 20, 2006, at 13:12:11
Here ya go Chris :-)
http://www.acnp.org/G4/GN401000046/CH046.html
A great read all around!
Here is another interesting fact from it. I didn't know that the SSRI's also surpress REM sleep like the MAOI's do!
"MAOIs have prominent effects on sleep and sleep architecture, including a decrease in total sleep time and suppression of REM (rapid eye movement) sleep. The occurrence of REM sleep suppression has been associated temporally with an improvement in mood (39). In fact, REM suppression is a property shared by most effective antidepressants, including TCAs, lithium, and serotonin reuptake inhibitors. The extent to which the REM suppression caused by MAOIs contributes to the antidepressant effect itself remains unclear (42). Tentatively, both changes in sleep patterns and antidepressant responses have been linked to alterations in 5-HT regulation. Of the RIMAs, brofaromine has similar effects on sleep as the irreversible agents, whereas moclobemide does not have a striking REM sleep suppressant effect (42,109)."
JH
> > "Both the irreversible MAOIs and the RIMAs rarely cause cardiac effects and at therapeutic doses have little effect on seizure threshold. Hepatotoxicity (e.g., progressive, necrotizing, hepatocellular damage) has occurred in some patients receiving MAOIs of the hydrazine type (e.g., phenelzine/Nardil) making it advisable to check liver function periodically in patients receiving high doses and in those receiving prolonged therapy with these drugs. Risk of hepatotoxicity with the non-hydrazine MAOIs (e.g., tranylcypromine/Parnate, pargyline, selegiline) and the RIMAs (e.g., moclobemide, brofaromine) is absent or minimal."
> >
>
> Interesting! BTW, do you happen to know the source? (It was a quotation after all.)
>
>
> - Chris
>
Posted by Phillipa on May 20, 2006, at 19:15:55
In reply to Interesting MAOI's info, posted by JaclinHyde on May 20, 2006, at 11:30:52
Well since from the article is sounds improbable these things will happen to you or another why stop using the MAOI's. Yes a few still do but in the US most don't that.s the why. Love Phillipa
Posted by Jost on May 20, 2006, at 19:44:40
In reply to Re: Interesting MAOI's info » JaclinHyde, posted by Phillipa on May 20, 2006, at 19:15:55
The statistics for hypertensive deaths may not account for the fact that in the early years, the hypertensive dangers of maois were known. If the deaths were grouped by years, it would be interesting.
Jost
Posted by linkadge on May 20, 2006, at 23:16:22
In reply to Re: Interesting MAOI's info, posted by Jost on May 20, 2006, at 19:44:40
THe only antidepressant I can think of which hasn't been shown to supress REM sleep is Wellbutrin.
Behaviorally, the REM supressors and Wellbutrin seem to have slightly different effects.
REM rebound is not fun at all. It is horrable.
Linkadge
Posted by Maximus on May 20, 2006, at 23:17:58
In reply to Re: Interesting MAOI's info, posted by JaclinHyde on May 20, 2006, at 12:28:53
> What's really why?
>
> JHRisk of overdose and lethal. That is why they are not prescribed anymore.
Posted by Phillipa on May 21, 2006, at 0:09:07
In reply to Re: Interesting MAOI's info » JaclinHyde, posted by Maximus on May 20, 2006, at 23:17:58
Maximus I know I'm thick what what is lethal? Love Phillipa ps I always picture you has a huge guy with a lot of strength.
Posted by Maximus on May 21, 2006, at 0:37:46
In reply to Re: Interesting MAOI's info » Maximus, posted by Phillipa on May 21, 2006, at 0:09:07
> Maximus I know I'm thick what what is lethal? Love Phillipa ps I always picture you has a huge guy with a lot of strength.
Hi,
Forgive my silly frenchness. It is often an exploit to understand fully what others psycho-babblers write.
Lethal = mortal
I'm just an average guy who has been very strong in an another life.
Posted by SLS on May 21, 2006, at 8:25:23
In reply to Re: Interesting MAOI's info, posted by linkadge on May 20, 2006, at 23:16:22
> THe only antidepressant I can think of which hasn't been shown to supress REM sleep is Wellbutrin.
What about trimipramine? It really is an odd-ball TCA.
I think Wellbutrin actually promotes REM sleep, although the effect is relatively small.
- Scott
Posted by Sobriquet Style on May 21, 2006, at 9:27:48
In reply to Re: Interesting MAOI's info, posted by SLS on May 21, 2006, at 8:25:23
http://www.epilepsy.com/epilepsy/sleep_aeds.html
Afew snippets;
"More recently, studies that carefully look at this, some by testing drugs in normal volunteers who do not have epilepsy, have clearly shown that anticonvulsants can either enhance or disrupt sleep independent of their effects on seizures.
Benzodiazepines (such as diazepam and lorazepam) and barbiturates( phenobarbital, primidone ) are used less commonly for chronic treatment of seizure disorders, but have the most convincing evidence for detrimental effects on sleep. Both of these classes of medications have been used as sleep promoting agents, although newer drugs have replaced these in recent years. They do decrease the time to fall asleep, but also decrease the amount of REM sleep and (in the case of benzodiazepines) slow wave sleep. Therefore, sleep quality can be adversely affected.
Findings for carbamazepine are more variable, but there also seems to be a reduction in sleep particularly with initial treatment.
Studies of newer AEDs suggest fewer detrimental effects on sleep. One study with lamotrigine showed decreases in slow wave sleep, but others have shown no change.
Gabapentin has no detrimental effects on sleep, and in fact seems to enhance slow wave sleep in patients with epilepsy and in normal volunteers. Gabapentin also increases sleep continuity and decreases awakenings. Furthermore, limited studies suggest that gabapentin may be useful in the treatment of one common sleep disorder, restless legs syndrome, although carbamazepine and lamotrigine have also been used.
Levetiracetam seems to have no detrimental effects on sleep.
The effects of zonisamide, oxcarbazepine, and topiramate on sleep and sleep disorders are not known."
A couple of good tables on the website too. Although this is more about antidepressants and sleep, I read this a while back and thought I'd throw it in..
~
Posted by JaclinHyde on May 21, 2006, at 11:56:14
In reply to Re: Interesting MAOI's info » JaclinHyde, posted by Maximus on May 20, 2006, at 23:17:58
Well as to them not being prescribed anymore judging by the amount of people on this board who are taking them and being helped by them I would say that you are mistaken.
And as to them being lethal....so is depression if left untreated. It's called suicide.
Just my .02
JH
>
> Risk of overdose and lethal. That is why they are not prescribed anymore.
>
>
Posted by Jost on May 21, 2006, at 14:32:47
In reply to Re: Interesting MAOI's info, posted by linkadge on May 20, 2006, at 23:16:22
> THe only antidepressant I can think of which hasn't been shown to supress REM sleep is Wellbutrin.
>
>
On parnate, I had more dreams (or at least I remembered more) than before. They were different, though--really creepy, and kind of numbing, sort of washed-out, and amazingly repetitive. They seemed to last for hours..Like I'd be trudging and trudging and trudging through deep snow, and I would get so tired that I would collapse, but, I'd utterly haul myself up and start walking again. Everything was gray and cold, with nothing in sight, an endless struggle. Ugh.
Then I would wake up absolutely exhausted.
Jost.
Posted by Maximus on May 21, 2006, at 15:33:46
In reply to Re: Interesting MAOI's info...Maximus, posted by JaclinHyde on May 21, 2006, at 11:56:14
> And as to them being lethal....so is depression if left untreated. It's called suicide.
I could not agree more with you. You're right. Untreated depression is almost lethal.
By not anymore, i was just meaning "marginal", "used as a last resort". I do know that MAOIs are still being used.
I wish you good luck with Marplan. It's a long way to find a good med.
Posted by linkadge on May 21, 2006, at 19:41:01
In reply to Re: Interesting MAOI's info...Maximus » JaclinHyde, posted by Maximus on May 21, 2006, at 15:33:46
Yes, I guess trimipramine does not supress REM sleep.
http://en.wikipedia.org/wiki/Trimipramine
Although, I've never heard of anyone getting a dynamic AD response to it.
My mother tried it and said it was horrible.
Although, I suppose it has worked for some people.
Linkadge
Posted by helpme on July 9, 2006, at 11:02:08
In reply to Anticonvulsants / Benzo's and Sleep..., posted by Sobriquet Style on May 21, 2006, at 9:27:48
Interesting. I have been taking klonopin for sleeping due to lots of strong myoclonus for awhile (which turned out to be itself a side effect of a drug) , plus limb movements and then had a sleep study. They found I had almost no slow wave sleep (the deep stage) at all! I'm tapering off the klonopin though. I convinced my doctor that too much dinkering pharmaceutically might just be trading one isssue for another. He agreed, saying, "without that super deep sleep, anyone would become depressed or develop any number of serious mental disorder...it's practically a recipee for how to screw someone up."
Gabepeptine--is that neurontin, the drug famous for "looking for a disease to be for"? Maybe they found it...
> http://www.epilepsy.com/epilepsy/sleep_aeds.html
>
> Afew snippets;
>
> "More recently, studies that carefully look at this, some by testing drugs in normal volunteers who do not have epilepsy, have clearly shown that anticonvulsants can either enhance or disrupt sleep independent of their effects on seizures.
>
> Benzodiazepines (such as diazepam and lorazepam) and barbiturates( phenobarbital, primidone ) are used less commonly for chronic treatment of seizure disorders, but have the most convincing evidence for detrimental effects on sleep. Both of these classes of medications have been used as sleep promoting agents, although newer drugs have replaced these in recent years. They do decrease the time to fall asleep, but also decrease the amount of REM sleep and (in the case of benzodiazepines) slow wave sleep. Therefore, sleep quality can be adversely affected.
>
> Findings for carbamazepine are more variable, but there also seems to be a reduction in sleep particularly with initial treatment.
>
> Studies of newer AEDs suggest fewer detrimental effects on sleep. One study with lamotrigine showed decreases in slow wave sleep, but others have shown no change.
>
> Gabapentin has no detrimental effects on sleep, and in fact seems to enhance slow wave sleep in patients with epilepsy and in normal volunteers. Gabapentin also increases sleep continuity and decreases awakenings. Furthermore, limited studies suggest that gabapentin may be useful in the treatment of one common sleep disorder, restless legs syndrome, although carbamazepine and lamotrigine have also been used.
>
> Levetiracetam seems to have no detrimental effects on sleep.
>
> The effects of zonisamide, oxcarbazepine, and topiramate on sleep and sleep disorders are not known."
>
> A couple of good tables on the website too. Although this is more about antidepressants and sleep, I read this a while back and thought I'd throw it in..
>
> ~
Posted by helpme on July 9, 2006, at 11:23:55
In reply to Re: Interesting MAOI's info...Maximus, posted by JaclinHyde on May 21, 2006, at 11:56:14
Indeed, I know they are being prescribed, too! My doctor is an expert psychopharmacologist, and he says that in the 60's people were having the cerebral hemorages and other problems because they didn't know about "the cheese effect". No one had any idea as to why people would suddenly have these deadly events, even thought it could be random-that the drugs themselves were doing it-BUT NOW THEY GET IT, so the events can largely be prevented. However, I understand people were spooked away for awhile and became interested in "safer improvements", like those harmless amphetamines that one could eat like candy to solve anything. But then people got a grip and the MAOIS came back in to use- for apparently they sometimes work when nothing else does and are said to be quite safe when guidelines are followed. Also, apparently doctors are still nervous about patients following the dietary and drug restrictions faithfully, and have keep that in mind when prescribing. So they are rarely the first choice drug. But given the choice between stubborn hell on earth that doesn't respond to other drugs or therapy, suicide, or giving up on good foods and cold medicine for a drug that works wonders to improve life and health- well- which does the critic think is least "lethal"?
No wonder the docs and pharmaceutical people are so excited about developing products like EMSAM! I hope this was just the beginning!
And lethal? Yes, suicide or becoming a helplessly hopeless depressed vegetable sure sound worse than the teeny chance of making a food mistake!! And you can OD on Tylenol , too. Can't single out something like MAOIS for that "overdose" accusation. Also, stress and depression hormones like cortisol are lethal too.
> Well as to them not being prescribed anymore judging by the amount of people on this board who are taking them and being helped by them I would say that you are mistaken.
>
> And as to them being lethal....so is depression if left untreated. It's called suicide.
>
> Just my .02
>
> JH
>
>
> >
> > Risk of overdose and lethal. That is why they are not prescribed anymore.
> >
> >
>
>
This is the end of the thread.
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Dr. Bob is Robert Hsiung, MD,
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