Psycho-Babble Medication Thread 618332

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Re: Many people fear MAOI's.... theo

Posted by SLS on March 11, 2006, at 23:37:10

In reply to Re: Many people fear MAOI's.... SLS, posted by theo on March 11, 2006, at 22:46:19

> Nevertheless, the antidepressant effect of Wellbutrin was quite evident once it was added. Both people take 300mg.
> >
> >
> > - Scott
> >
>
> Which version, regular, SR, XL? Which is more effective?

Both people currently take the XL version. One claims that she prefers the SR. The regular version often produces too many ups and downs throughout the day and can lead to dysphoria. The extended release versions are said to be smoother and reported to "feel" more effective by some people.

I've been given samples of the Wellbutrin XL which I am supposed to start taking two days from now. Wellbutrin (regular) has made me feel worse in the past. My doctor would like to see how I respond to it while taking Lamictal at the same time. I guess he wants to see for himself. I am anticipating feeling worse on Wellbutrin XL, despite my never having taken an extended release version or having combined it with the drugs I take currently.

I'll probably end up back on Nardil until something new comes out or when rTMS is approved to treat depression. I'm having a difficult time embracing EmSam (selegiline) as a treatment in my case. I didn't respond to the oral version, and Parnate represents a dead end. Then again... Who knows. A doctor at the NIMH suggested that I revisit selegiline because it is a propargyl derivative, and I once responded to clorgyline, which is also a propargyl MAOI. It's too bad pargyline (Eutonyl), a propargyl selective MAO-B inhibitor, is no longer available. I would have tried it. My guess, though, is that neither selegiline nor pargyline are as broadly effective as Parnate or Nardil. MAO-A seems to be more important when treating severe depression.


- Scott

 

Re: Many people fear MAOI's....

Posted by JaclinHyde on March 12, 2006, at 0:03:47

In reply to Re: Many people fear MAOI's.... Chairman_MAO, posted by SLS on March 11, 2006, at 21:15:39

Wellbutrin brought back my hypochondria after having it lay dormant for over 20 years and gave me a non stop menstrual period. Should have taken out stock in tampax (sorry guys.)

JH

 

Re: Many people fear MAOI's.... SLS

Posted by Chairman_MAO on March 12, 2006, at 0:47:32

In reply to Re: Many people fear MAOI's.... Chairman_MAO, posted by SLS on March 11, 2006, at 21:15:39

Have you heard of anyone who gets a better effect from bupropion than long-acting methylphenidate, d-amphetamine, or desipramine?

I often wonder whether the people who do well on Wellbutrin simply aren't aware of how much better some other medications are, much like buspirone vs. diazepam.

 

Re: Many people fear MAOI's.... SLS

Posted by Chairman_MAO on March 12, 2006, at 0:51:22

In reply to Re: Many people fear MAOI's.... theo, posted by SLS on March 11, 2006, at 23:37:10

I wish some of these doctors would TAKE Wellbutrin so they could feel how dysphoric it is. The reason it lacks abuse potential is simply because, in reality, it has an abysmal therapeutic index. Severe depression, IMHO, often requires more like 600-900mg of this drug. I have no idea how anyone tolerates that level of anxiety.

I strongly urge you to try buprenorphine along with an MAOI.

 

Re: Many people fear MAOI's.... bassman

Posted by Chairman_MAO on March 12, 2006, at 1:26:01

In reply to Re: Many people fear MAOI's...., posted by bassman on March 11, 2006, at 19:53:27

These clinicians suffered from a profound lack of insight, then. What other rationale is there for using methadone (a long-acting opioid) in treating dependency? Why do people tend to find Wellbutrin XL, Concerta, etc. more tolerable than the IR forms? Why is it that cigar smokers tend to have an easier time quitting than cigarette smokers? What about those who take cocaine via IV vs. buccally?

Pharmaceutical companies are not exactly known for their scruples. Methaqualone was supposedly the "non-addictive" barbiturate replacement, and yet it is almost universally preferred by drug abusers! Heroin was billed as the non-habit-forming morphine.

Diazepam could be more addictive for some given that it is more lipophilic, so it kicks in faster and is more psychologically reinforcing. However, in practice its multiple active metabolites probably make up for this. Upjohn simply made it all up, just like Eli Lilly completely fabricated the "chemical imbalance" rationale for Prozac's efficacy.

Any user of benzodiazepines for round-the-clock anxiolysis will naturally take however many doses per day necessary to maintain consistent blood levels. By Upjohn's argument, heroin would not induce dependence--unlike methadone. Absurdity!

 

Re: Many people fear MAOI's....Jaclin Hyde

Posted by cecilia on March 12, 2006, at 1:49:18

In reply to Re: Many people fear MAOI's...., posted by JaclinHyde on March 10, 2006, at 19:12:41

I'm glad that MAOI's work for you, but I don't understand why you keep saying the success rate is 99%. It's closer to 50%. Please, if you have a link to a reputable study showing a 99% success rate, I'd be very curious to see it. Cecilia

 

Re:MAOI Success rate....Jaclin Hyde

Posted by cecilia on March 12, 2006, at 2:51:14

In reply to Re: Many people fear MAOI's....Jaclin Hyde, posted by cecilia on March 12, 2006, at 1:49:18

I mean, quite aside from the fact that no treatment for depression has ever shown anywhere near a 99% success rate, it would be virtually impossible to have a placebo controlled trial that showed this. The only way it could be done would be to have only a 1% placebo success rate, and I've never heard of any AD study that had anywhere near that low a rate of placebo success. Most AD studies have at least a 30% placebo success rate, so even in the extremely unlikely event that a study showed a 99% success rate, if you subtracted the 30% placebo sucess you'd only get a 69% success rate. Cecilia

 

Re: Many people fear MAOI's.... SLS

Posted by theo on March 12, 2006, at 6:58:28

In reply to Re: Many people fear MAOI's.... theo, posted by SLS on March 11, 2006, at 23:37:10

> I'll probably end up back on Nardil until something new comes out or when rTMS is approved to treat depression. I'm having a difficult time embracing EmSam (selegiline) as a treatment in my case. I didn't respond to the oral version, and Parnate represents a dead end. Then again... Who knows. A doctor at the NIMH suggested that I revisit selegiline because it is a propargyl derivative, and I once responded to clorgyline, which is also a propargyl MAOI. It's too bad pargyline (Eutonyl), a propargyl selective MAO-B inhibitor, is no longer available. I would have tried it. My guess, though, is that neither selegiline nor pargyline are as broadly effective as Parnate or Nardil. MAO-A seems to be more important when treating severe depression.
>
>
> - Scott

I wish a Nardil patch was available, that could be taken in small doses without food restriction. I want to try the EmSam patch but hate to stop everything just to try something new. How did the oral Selegiline make you feel? Did it help at all?

Ted

 

Re: Many people fear MAOI's.... theo

Posted by SLS on March 12, 2006, at 8:09:44

In reply to Re: Many people fear MAOI's.... SLS, posted by theo on March 12, 2006, at 6:58:28

> I wish a Nardil patch was available, that could be taken in small doses without food restriction. I want to try the EmSam patch but hate to stop everything just to try something new. How did the oral Selegiline make you feel? Did it help at all?

Hi Ted.

I don't remember Eldepryl doing anything positive or negative. Then again, I didn't go higher than 30mg.

I don't know if there would be any advantage to using a patch for delivering Nardil. I should think that the dosage necessary to treat depression would be too high to be able to eliminate the tyramine diet. I'm not sure, though.

I'm not sure the hypertensive reaction to foods is completely understood. I would treat any MAOI with respect, regardless of selectivity or reversibility.


- Scott

 

Re: Many people fear MAOI's....

Posted by SLS on March 12, 2006, at 8:18:49

In reply to Re: Many people fear MAOI's.... SLS, posted by Chairman_MAO on March 12, 2006, at 0:51:22

> I wish some of these doctors would TAKE Wellbutrin so they could feel how dysphoric it is. The reason it lacks abuse potential is simply because, in reality, it has an abysmal therapeutic index. Severe depression, IMHO, often requires more like 600-900mg of this drug. I have no idea how anyone tolerates that level of anxiety.

I had taken 600mg for several weeks, and 900mg for several weeks more. I did not experience any anxiety at all. I did experience dysphoria, though. What is interesting is that I also experienced a withdrawal rebound improvement when I discontinued it.

> I strongly urge you to try buprenorphine along with an MAOI.

My first hurdle is to get my doctor to prescribe Nardil in combination with the nortripyline I am currently taking. Once I accomplish that, I'll then plant the seed of using buprenorphine. He seems to think that there is a synergy between Wellbutrin and Lamictal. I guess I should let him take his best shot at this point. I am trying to prepare myself for the dysphoria and general worsening of my condition that I anticipate will be induced by Wellbutrin. I don't see how Lamictal - or any other drug - would change so profoundly how my brain reacts to Wellbutrin. However, it is hard for me to pass up any reasonable treatment at this point. We'll see.

Have you ever heard of Wellbutrin affecting vision?


- Scott

 

Re: Many people fear MAOI's.... SLS

Posted by ed_uk on March 12, 2006, at 10:18:14

In reply to Re: Many people fear MAOI's.... theo, posted by SLS on March 12, 2006, at 8:09:44

Hi Scott

>I don't know if there would be any advantage to using a patch for delivering Nardil.

I don't think it would eliminate the risk either, but I do expect it would reduce tyramine sensitivity to some extent. I not sure whether it would be possible to administer phenelzine transdermally though, many drugs are not suitable for this method of administration. There are many reasons for this eg. some drugs cannot be absorbed in adequate quantities via the skin.

Regards

Ed

 

Re: Many people fear MAOI's.... Chairman_MAO

Posted by Phillipa on March 12, 2006, at 16:57:42

In reply to Re: Many people fear MAOI's.... bassman, posted by Chairman_MAO on March 12, 2006, at 1:26:01

Wait a minute I take offense to that statement. I've been on a benzo for over 30yrs and have always taken the lowest I could. It's just recently that my pdoc raised my valium to 20mg at night only. And I only take it at night because of the long half life. Fondly, Phillipa

 

Re: Many people fear MAOI's....cecilia

Posted by JaclinHyde on March 12, 2006, at 19:49:34

In reply to Re: Many people fear MAOI's....Jaclin Hyde, posted by cecilia on March 12, 2006, at 1:49:18

> I'm glad that MAOI's work for you, but I don't understand why you keep saying the success rate is 99%. It's closer to 50%. Please, if you have a link to a reputable study showing a 99% success rate, I'd be very curious to see it. Cecilia

First of all I don't 'keep' on saying it. If I am not mistaken this is the second time out of I don't know how many posts that I mentioned that. And it is a figure that I DO remember reading somewhere on the web and will dig for again. In the meantime here is one which states a 70% success rate, not 50% like you think....

"Current research suggests that the monoamine oxidase inhibitors (MAOIs), especially phenelzine, are the most highly effective medications for treating social phobias. In studies, about 70% of subjects improve significantly within four weeks. Occasionally, however, a social phobic can experience an exaggerated response to an MAOI and become too talkative, outgoing or socially uninhibited. In that case the prescribing physician will lower the medication dosage or stop it altogether."

JH

 

Re: Many people fear MAOI's....cecilia

Posted by JaclinHyde on March 12, 2006, at 19:53:13

In reply to Re: Many people fear MAOI's....Jaclin Hyde, posted by cecilia on March 12, 2006, at 1:49:18

> I'm glad that MAOI's work for you, but I don't understand why you keep saying the success rate is 99%. It's closer to 50%. Please, if you have a link to a reputable study showing a 99% success rate, I'd be very curious to see it. Cecilia

Or we have this one that states a 60 - 85% success rate.

"MAOIs: These medications, in general, have been shown to work effectively approximately 60-85% of the time for people with clinical social anxiety. Most people with social anxiety do not need this medication, however.

If a medication is needed in addition to the anti-anxiety agents, these medications have been shown to work best for social anxiety disorder. Although most of our generalized social anxiety people do NOT need to be on these medications, people with more avoidant behaviors DO need the added benefits of an MAOI.

We have found that, in general, Parnate, as opposed to Nardil, is more effective with (generalized) social anxiety disorder, provided there are no other anxiety or mental health care complications. (Nardil has been shown by research to be effective, also, although we have yet to see anyone tolerate this medication. If an MAOI is considered, we recommend Parnate over Nardil, due to Parnate's added noradrenergic and dopaminergic effects). People with avoidant personality disorder are usually greatly helped by this medication. Although these medications require slight food restrictions, the current restriction list (even as far back as of 1998) is quite small. No responsible adult who needs to be on an MAOI, and is receiving help from the medication, has ever complained about the food restrictions.

Our more severely socially-anxious individuals (currently being termed "avoidant personality disorder") may need to use these medications, under proper psychiatric care. Again, Parnate works faster, has less side effects, is uplifting and motivating for people with social anxiety and is preferred over Nardil. Talk with your social anxiety therapist about this first, and get a recommendation to a psychiatrist who understands social anxiety and this particular medication in general. You will not typically be able to obtain one of the MAOIs from your general practitioner, as they are usually unaware of the positive effects these medications can play in helping people with social anxiety."

 

Re: Many people fear MAOI's....cecilia

Posted by JaclinHyde on March 12, 2006, at 20:14:10

In reply to Re: Many people fear MAOI's....cecilia, posted by JaclinHyde on March 12, 2006, at 19:53:13

And although it doesn't give any numbers, I sure do like the way the crazymeds.org talk about them (and every other pill for that matter :-)

http://www.crazymeds.org/

JH

 

Re: Many people fear MAOI's.... Phillipa

Posted by Chairman_MAO on March 12, 2006, at 21:49:51

In reply to Re: Many people fear MAOI's.... Chairman_MAO, posted by Phillipa on March 12, 2006, at 16:57:42

I do not understand why you took offense to my statement. All I said was that any user of benzodiazepines takes however many doses necessary per day to maintain consistent blood levels. In your case, you only need one dose because you're getting the relief you need from its active metabolites (I have stated in the past that many cases of "GAD" can be treated with 10mg diazepam at night). Diazepam itself does not have a long half-life. In fact, it diffuses rapidly in and out of the CNS (faster than any other benzodiazepine, which is why it is the treatment of choice for status epilepticus).

There may be people out there who malign users of benzodiazepines as "drug addicts"--as if there are "good" and "bad" drugs. I am not one of them.

"Take a chill pill, man. ;)"

 

Re: Many people fear MAOI's.... ed_uk

Posted by Chairman_MAO on March 12, 2006, at 21:51:45

In reply to Re: Many people fear MAOI's.... SLS, posted by ed_uk on March 12, 2006, at 10:18:14

You can administer just about anything transdermally with dimethyl sulfoxide.

Most people don't like smelling like a clove of garlic, though. :)
.

 

Re: Many people fear MAOI's.... Chairman_MAO

Posted by Phillipa on March 12, 2006, at 22:38:20

In reply to Re: Many people fear MAOI's.... ed_uk, posted by Chairman_MAO on March 12, 2006, at 21:51:45

Chairman I know you know more than I do about meds but then why to they say thet diazapam has a long halflife that if weaning off of xaxax or a short acting benzo or alcholism that valium is the drug to use. When I worked in detox they started you at high dose of diazepam and daily lowered your dose until in a few days you only on let's say 5mg a day when four days before you were taking 60mg of diazepam. And no withdrawal. And it is not a chill pill . If it were I'd probably abuse it. Fondly, Phillipa ps they use up to 20mg of klonopin for seizures.

 

Re: Many people fear MAOI's....Jaclin Hyde

Posted by cecilia on March 13, 2006, at 1:32:28

In reply to Re: Many people fear MAOI's....cecilia, posted by JaclinHyde on March 12, 2006, at 20:14:10

I don't know where these quotes are from, but if the person who wrote the 2nd one has never seen anyone tolerate Nardil, than it seems like he should be listing a zero percent success rate for this med. And the "Crazy Meds" outdated statement that chocolate is forbidden would keep practically anyone from trying MAOI's. But I know your intentions are good, many people are afraid of MAOI's and it's good to encourage people to try them. Like every med, they do help some people who have failed at other meds and are certainly worth a try. It's just that it's so discouraging for someone like me, and many other Psychobabblers, who have failed all the MAOI's to be told that there's a 99% success rate. Seeing this 99% statistic written by you, or Ace's frequent claim of 90% (again, without studies listed) gives me a feeling of being such a hopeless failure, even though I know that depression would be virtually nonexistent and there would be no need for Psycho-babble to exist if these statistics were true. I know, that technically it's not me that's failed, it's the drugs that have failed, but having failed, or been failed by, Marplan, Nardil, Parnate, Moclobemide, Desipramine, Imipramine, Trazadone, Prozac, Zoloft, Paxil, Wellbutrin, Effexor, Serzone, Buspar, St. John"s Wort, Remeron, Nortriptyline, Celexa, Gabapentin, SAM-e, Methylphenidate, Dexedrine, Olanazapine, Amisulpride, Reboxetine, Lamictal, Tianeptine, Duloxetine, Milnacipran, Adrafinil, Luvox, 5-HTP and rTMS, it just hurts a lot to have these statistics suggesting that anyone could overcome depression if they just used the right meds. Cecilia

 

Re: Many people fear MAOI's.... cecilia

Posted by jedi on March 13, 2006, at 2:50:13

In reply to Re: Many people fear MAOI's....Jaclin Hyde, posted by cecilia on March 13, 2006, at 1:32:28

cecilia,
I sure feel for your suffering. With all of the meds you have tried, were there any that gave some relief? I haven't read what your diagnosis is, but from your posts I am assuming it is treatment resistant major atypical depression with social or generalized anxiety disorder. If so, you are very similar to me in that regard. If the selegiline patch does not help, may I suggest another try with Nardil. Many people take a full six to eight weeks after the effective dose of 1mg/kg is reached before results are seen. This is sometimes very hard to achieve because of the early and varied side effects of the medication. For me, the worst was the weight gain, since my atypical depression had already moved that in the wrong direction. However, without this drug, I would not be alive today to write this note to you. If, for any reason, you or your doctor cut off your trial of Nardil before being at the effective dose for six weeks, please try the med again. It is only used on treatment resistant patients, and when it does work it can open the world to you again.
Wishing you the best,
Jedi

 

Re: Many people fear MAOI's....Jaclin Hyde cecilia

Posted by RobertDavid on March 13, 2006, at 11:07:06

In reply to Re: Many people fear MAOI's....Jaclin Hyde, posted by cecilia on March 13, 2006, at 1:32:28

Cecilia:

I'm don't know you're diagnosis, but in reading the meds you've tried I can certainly understand how discuraged you must feel. I too have had little help with any medicine besides klonopin for my social and generalized anxiety.

But some people who feel depressed, tired, moody, trouble concentrating, anxious, etc. (not saying that's you) are perscribed medicines such as those you've tried (with no help) when in fact are not properly diagonosed with sleep apnea. My brother is one of those and I have a mild case. I now sleep with a CPAP machine which has helped my mood, energy and mental clarity. I'm less anxious too.

I'm just throwing it out there as a thought. If you are aware that you snore, even a little or if you or someone else has noticed you gasp for air at night, you might want to get checked and rule that out.

Otherwise, perhaps your trial with EMSAM will help. I'll be trying it as well. Best of luck to you.....

 

Re: Many people fear MAOI's....Jaclin Hyde cecilia

Posted by Caedmon on March 15, 2006, at 19:11:00

In reply to Re: Many people fear MAOI's....Jaclin Hyde, posted by cecilia on March 13, 2006, at 1:32:28

I don't understand why someone would claim that MAOIs have a 99% success rate. This does not sound remotely accurate to me. (What would "success rate" even mean? Statistically significant improvement? Complete remission?)

I have never seen an article in a peer-reviewed journal stating that this is true. I have also never seen reliable statistics showing a 90% "success rate", again, whatever this means. I find such statements puzzling.

MAOIs can be very powerful and helpful antidepressants. But I have also known more than a few people who have gone on full trials of MAOIs, only to either d/c due to side effects, or fail to respond altogether.

Cecilia, have you ever tried Lithium? I didn't see that listed on your big list o' meds.

 

Re: Many people fear MAOI's....Caedmon

Posted by cecilia on March 15, 2006, at 22:14:37

In reply to Re: Many people fear MAOI's....Jaclin Hyde cecilia, posted by Caedmon on March 15, 2006, at 19:11:00

Forgot about that one, Caedmoan, yes I did try a brief trial of lithium to "augment" Zoloft, but couldn't take the side effects. It was like get up, throw up, morning sickness without being pregnant. I suppose I probably should have stuck it out longer. When I first got the courage to start the med-go-round (after being depressed for over 20 years) I had a tendency to give up on meds too early, and some that have had minimal side effects when I tried them the first time had much worse side effects upon retrial. It's so hard to know how long to try something for-whether you're giving something a sensible trial or just keeping on with a trial as punishment for being depressed. This whole med game is like playing Russian roulette-swallowing substance after substance with no idea of what it's going to do to your body or mind. Cecilia

 

Re: Many people fear MAOI's.... RobertDavid

Posted by seekinggrace on April 8, 2007, at 16:18:29

In reply to Re: Many people fear MAOI's...., posted by RobertDavid on March 10, 2006, at 21:44:30

> I'm saw my psychiatrist yesterday and I'm trying my first MAOI, EMSAM (when it's at the pharmacy). I have SP with some depression. If EMSAM doesn't work I'll be going to Nardil then Parnate.
>
> I'm hopeful it will work though, my doc thinks it will particularly if I blend it with the klonopin I now take. Ultimately I'll try it in mono therapy, but if I need both, great.
>
> Though we did review the significant food restrictions for MAOI's such as aged cheeze, he told me not to worry about it. That I just needed to watch certain other meds like SSRI's, certain pain killers, etc. He suggested that even at higher doses of 30 and 40mgs there shouldn't be food issues, it's just that it wasn't approved without food issues at those doses.
>
> He also suggested that the side effects of EMSAM will be even less than SSRI's and other anti depressants. So an MAOI without diet concerns, fewer side effects (weight gain, libido issues) that may help my anxiety and depression, I'm going for it. Lastly, the once a day steady dosing via the patch.
>
> It all sounds to good to be true. Hopefully it will be, If not, I'm with those of you who deal with the issues of Nardil/Parnate. All I care about anymore is quality of life. I'll gladly trade a few side effects for something that actually works.

Hi, I'm so curious how emsam is working for you. I'm on my 8th day. At first it seemed to be helping a bit - but this weekend has been just shy of intolerable with the depression and constant crying. I'm on 6 mg - the smallest. Are you having good results? Thanks

 

Re: Many people fear MAOI's.... seekinggrace

Posted by RobertDavid on April 8, 2007, at 20:58:11

In reply to Re: Many people fear MAOI's.... RobertDavid, posted by seekinggrace on April 8, 2007, at 16:18:29

> Hi, I'm so curious how emsam is working for you. I'm on my 8th day. At first it seemed to be helping a bit - but this weekend has been just shy of intolerable with the depression and constant crying. I'm on 6 mg - the smallest. Are you having good results? Thanks


It's been a year since my first post regarding EMSAM. I am no longer taking EMSAM and am currently only taking one medicine for GAD/SAD, Klonopin. I believe the mild depression I used to feel was more of a side effect of the anxiety disorters I have. I was tired, had poor concentration and felt somewhat depressed.

While on EMSAM my concentration and mood was improved. I felt a pretty quick response to it. The only troublesome side effect was initially I wasn't sleeping as well as I like to.

With my doctors consent I tried various things to improve that. I cut the patch in half for a while. I also tried taking it off a few hours before bedtime, then back on in the morning. Both things helped with my sleeping issues somewhat.

During the time I was taking EMSAM I played with my Klonopin dose and landed no 1.5mgs which is were I am today, down from a high of 3mgs.

Long story long I really looked hard at all aspects of my life and started eating better, working out regularly, etc. I felt better and ended up finding that the lifestyle changes I had made allowed me to stop EMSAM as my mood was better and had more energy. Perhaps the downward adjustment of Klonopin helped as well (I believe I was at 2mgs Klonopin when I started EMSAM).

For me EMSAM was helpful only to take as a blend with Klonopin (Klonopin for anxiety, EMSAM for mood). I would not hesitate to go back on it should the minor depression I felt returned.

Anyway, I hope it works for you. It's a resonable option particularly for those that have failed with other medicines. If you can tolerate the side effects I'd suggest you give it at least 8 weeks and see where you're at then. Perhaps talk to your doctor about adjusting the dose if things don't improve for you.

Best of luck to you and hang in there. There's a solution for you and this may be it.....


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