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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 22 of 22. This is the beginning of the thread.
Posted by floatingbridge on August 4, 2009, at 22:53:22
Hi,
Is it because after a round on an MAO, other meds don't work? (My doc seems to project it as an end of the line type of treatment.)
Are liability issues at play, too?
puzzled by my mao resistant pdoc,
fb
Posted by ricker on August 4, 2009, at 23:14:48
In reply to MAO's: why do doctors avoid them?, posted by floatingbridge on August 4, 2009, at 22:53:22
Hard to say. Maybe some docs feel it's best to exhaust all other option due to the potential for adverse reactions?
It reminds me of my Nardil experience back in 1989.... woke up coughing, half asleep and took 2 teaspoons of cough syrup..... woke up in the E.R. and my p/doc stopped in to see me the next mourning and said "we're stopping Nardil"!!!
It was the weirdest feeling I have ever experienced, conscious, yet totally out of it.
2 weeks later and I was on clomipramine. Maybe some docs have had some bad experiences with patients and avoid prescribing Mao's.
Regards, Rick
Posted by yxibow on August 5, 2009, at 0:21:43
In reply to MAO's: why do doctors avoid them?, posted by floatingbridge on August 4, 2009, at 22:53:22
> Hi,
>
> Is it because after a round on an MAO, other meds don't work? (My doc seems to project it as an end of the line type of treatment.)
People on MAOIs here may disagree because they have worked fantastically for their own situations, but personally I believe that it is a latter form of treatment and it is your body, not their conditions and everyone is different....
....(I'm not sure what end of the line really is... that's sort of a metaphysical concept in part, yes... I know about TRD, but there is the possibility of polypharmacy)> Are liability issues at play, too?
Yes.... not just liability in the sense of malpractice but drug liability.
They're up there in my belief beyond (at least short term use of) conventional antipsychotics in terms of lethal side effect liability.
> puzzled by my mao resistant pdoc,
Why not discuss it with him and ask his reasoning -- he may have had serious problems with some patients.
> fb
-- Jay
Posted by Phillipa on August 5, 2009, at 0:33:35
In reply to Re: MAO's: why do doctors avoid them? » floatingbridge, posted by yxibow on August 5, 2009, at 0:21:43
Mine used to use them and stopped due to unresponsible patients and bad reactions even the one lady on emsam. As she was almost going to let me try it and changed her mind. But a lot have done on the low mg patch no bad reactions except maybe insomnia and rash. Just per my pdoc. Phillipa
Posted by Sigismund on August 5, 2009, at 0:43:36
In reply to Re: MAO's: why do doctors avoid them?, posted by Phillipa on August 5, 2009, at 0:33:35
Try a doctor with no drug company paraphenalia on the desk and there is a chance of a better outcome.
Also, get older. Once you get older they get better or they give up.
Maybe they just don't have to feel they are in locus parentis?
Posted by Phillipa on August 5, 2009, at 0:47:17
In reply to Re: MAO's: why do doctors avoid them?, posted by Phillipa on August 5, 2009, at 0:33:35
Found this not much on google. Phillipa
http://psychiatrist-blog.blogspot.com/2008/03/why-this-shrink-doesnt-prescribe-maois.html
Posted by SLS on August 5, 2009, at 6:26:40
In reply to MAO's: why do doctors avoid them?, posted by floatingbridge on August 4, 2009, at 22:53:22
> Hi,
>
> Is it because after a round on an MAO, other meds don't work? (My doc seems to project it as an end of the line type of treatment.)
>
> Are liability issues at play, too?
>
> puzzled by my mao resistant pdoc,
>
> fb
Perhaps they don't trust their patients to adhere to the contraindications. Why risk the liability? Also, I think today's middle-aged doctors had the crap scared out of them in medical school. However, interest is now growing in medical schools to return to the MAOIs. They are no longer seen as demons, but as legitimate tools.My doctor is scared of Parnate because one of his patients reported developing a headache at some point during their initial titration. There was no indication that it was the classic occipital headache due to tyramine ingestion. I believe I was his first patient to break the 60mg barrier. It's funny because he was already aware of Jay Amsterdam's work with dosages of 120+mg.
Education of doctors and patients is critical. I think doctors also need to evaluate the functional level and personality of the patient so as to feel comfortable with patient adherence to the contraindications.
In 1982, the Columbia University depression program wanted to make an MAOI their very first drug to try on me. My, how things have changed.
- Scott
Posted by zana on August 5, 2009, at 9:20:30
In reply to Re: MAO's: why do doctors avoid them?, posted by SLS on August 5, 2009, at 6:26:40
I think one of the reasons is that becaue MAOIs are conterindicated with so many other meds that you might have to wash out period with the other meds that you are on. This means a possibly protracted period of discontinuation syndromes and time being off all meds before starting. I know that is a concern which my pdoc has raised. And after all that, they might not work well. So it's a big investment of time and discomfort.
That's my take on it. My pdoc's have been more uncomfortable about prescribing TCAs because of the possibliliy of suicide than of MAOIs.
Zana
Posted by atypical on August 5, 2009, at 10:12:50
In reply to MAO's: why do doctors avoid them?, posted by floatingbridge on August 4, 2009, at 22:53:22
Why doctor's avoid MAOIs? Well, some may not avoid them but rather wait and see what other classes of medications do for the depression/anxiety. Because they do have some weird side effects those MAOIs. Weird and uncomfortable and, yes, with the diet issues potentially dangerous. Imagine if a doctor were to prescribe MAOIs to a patient as a first-line treatment. Those side effects would hit them hard and they, if they are new to meds, would probably think the doctor was killing them and that meds are horrible! This is my theory.
Sure, there is some liability as well I guess. My doctor is at a major university, so she's covered well I'm sure.
I'm taking Nardil 60mg and so far the bad side effects have passed. Just have some milder ones now. Been on it for a month so far.
Posted by ColoradoSnowflake on August 5, 2009, at 11:25:03
In reply to Re: MAO's: why do doctors avoid them? » Phillipa, posted by Phillipa on August 5, 2009, at 0:47:17
Phillipa,
Thanks for posting that link!! I just read it all and found it extremely interesting!! I didn't realize how lucky I am that my pdoc not only prescribes MAOIs, but augments with (TCA) nortriptyline! After 18 years this is the first remission I've had!
My pdoc is 70 years old and did his residency and some teaching at U of Colorado Med School, as well as some years with a lot of psych inpatients. Maybe that's why he's so comfortable with them. He said he's never had a patient have a very bad reaction, but has seen lots of refractory patients respond to them and nothing else!.
I wish I would have listened to him years sooner.I'm so glad I finally did!
I imagine he takes on more potential legal risk. Maybe taking care in choosing patients he knows will observe the restrictions is the important factor.
After the first couple of weeks I haven't found the restrictions to be any big deal. I eat a fresher healthier diet. I wear a Medic-Alert bracelet so I wouldn't inadvertantly be given Demerol and that gives me even more peace of mind.
I am really on the Parnate/Nortriptyline bandwagon!! I pray this remission lasts!!
gayleParnate 50mg
Nortriptyline 25mg
Provigil 100-200mg
Posted by floatingbridge on August 5, 2009, at 11:41:22
In reply to Re: MAO's: why do doctors avoid them? » Phillipa, posted by Phillipa on August 5, 2009, at 0:47:17
Phillipa, you are the reigning google queen! The comments to the blog post are very interesting.
thanks
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Posted by floatingbridge on August 5, 2009, at 11:47:32
In reply to Re: MAO's: why do doctors avoid them? » floatingbridge, posted by yxibow on August 5, 2009, at 0:21:43
Yes, Jay--good idea. I'll just ask him why his reluctance. He's always been, it seems, straight forward. thanks!
fb
Posted by floatingbridge on August 5, 2009, at 11:51:02
In reply to MAO's: why do doctors avoid them?, posted by floatingbridge on August 4, 2009, at 22:53:22
Thanks for the responses! I have one more question, if anyone cares to address it. Has anyone taken an MAO and then gone 'back' to ssri's etc.? Ricker, I know you have. I mean, it's a reversible step, right?
fb
ooops...three posts in a row--a babble no-no!
Posted by Justherself54 on August 5, 2009, at 13:26:06
In reply to Re: MAO's: why do doctors avoid them? » floatingbridge, posted by floatingbridge on August 5, 2009, at 11:51:02
I have gone back to SSRI's after trials with both Parnate (twice) and Nardil. Would have stayed with Nardil, but a serious side effect made it impossible.
My pdoc was very open to MAOI's..although he has to be comfortable that his patients are compliant with the food and med interactions..
Posted by rvanson on August 8, 2009, at 23:36:26
In reply to Re: MAO's: why do doctors avoid them?, posted by Sigismund on August 5, 2009, at 0:43:36
> Try a doctor with no drug company paraphenalia on the desk and there is a chance of a better outcome.
>
> Also, get older. Once you get older they get better or they give up.
> Maybe they just don't have to feel they are in locus parentis?Thats no joke. When it comes to Pdocs the young ones are the worst for playing it safe and just using the SSRI/SSNI's.
You can forget about benzos with most of them.
They are addictive (and they work great on anxiety when nothing else does) so
they dont want you to become a "drug addict", right?
Posted by morganpmiller on August 8, 2009, at 23:50:31
In reply to Re: MAO's: why do doctors avoid them? » Sigismund, posted by rvanson on August 8, 2009, at 23:36:26
> > Try a doctor with no drug company paraphenalia on the desk and there is a chance of a better outcome.
> >
> > Also, get older. Once you get older they get better or they give up.
> > Maybe they just don't have to feel they are in locus parentis?
>
> Thats no joke. When it comes to Pdocs the young ones are the worst for playing it safe and just using the SSRI/SSNI's.
>
> You can forget about benzos with most of them.
>
> They are addictive (and they work great on anxiety when nothing else does) so
> they dont want you to become a "drug addict", right?
>Personally I think avoiding benzos is a good thing. Not only do you avoid a possible addiction, but you get to find out if an antidepressant alone is enough to treat your anxiety issue. Plus, Benzos are CNS depressants and may interfere with the efficacy of drugs like SSRIs in the same way that alcohol may interfere.
>
Posted by Sigismund on August 10, 2009, at 0:44:37
In reply to Re: MAO's: why do doctors avoid them? » Sigismund, posted by rvanson on August 8, 2009, at 23:36:26
>When it comes to Pdocs the young ones are the worst for playing it safe and just using the SSRI/SSNI's.
Well, the news is coming in, and once it's all in the SSRIs will be in the same boat as the benzos, more or less, give or take a bit.
The doctors I know speak like that now.
Which is why they don't particularly mind MAOIs any more than anything else.
Posted by Sigismund on August 10, 2009, at 0:51:24
In reply to Re: MAO's: why do doctors avoid them?, posted by morganpmiller on August 8, 2009, at 23:50:31
>Personally I think avoiding benzos is a good thing.
Me too.
Though here's an idea for a double blind study. To compare the effect on mental state of opiate vs benzo.
Really, I think the money (give the mental health budget to the travel agents) would be better spent on giving people a holiday.
Given the price of US drugs it might be a bargain. By the time you'd walked from Patagonia to Alaska your problems would have faded as well.
My psychiatrist speaks movingly in favour of this option. He thought (even!) casinos would be better, which was quite funny.
Posted by softheprairie on August 10, 2009, at 4:20:24
In reply to Re: MAO's: why do doctors avoid them? » Phillipa, posted by Phillipa on August 5, 2009, at 0:47:17
Thank you, Phillipa, for the blog link. It was fascinating. I read that blog post and all of the responses. Makes me grateful for my pdoc, who started practicing before the SSRI era and has experience prescribing the now-less-used classes of meds.
Posted by softheprairie on August 10, 2009, at 4:28:09
In reply to Re: MAO's: why do doctors avoid them? » floatingbridge, posted by floatingbridge on August 5, 2009, at 11:51:02
> Has anyone taken an MAO and then gone 'back' to ssri's etc.?
Yes, I went from MAOI to tricyclic. I was on selegiline (tried in two different formats, EMSAM, then Zelapar) and got some benefit from it, but not enough. That was with some adjunct help, too, plus pushing to high doses of selegiline. I switched to desipramine and that is the antidepressant of my current coctail, and I am pleased with it, even though it has side effects.
Posted by CaptainAmerica1967 on August 11, 2009, at 21:23:25
In reply to MAO's: why do doctors avoid them?, posted by floatingbridge on August 4, 2009, at 22:53:22
https://www.portsidetechnologies.com/thecarlatreport/documents/general/TCR.pdf
Drs misinformed some on hypertensive crisis as newer studies show foods once thought as no no are ok.
Posted by floatingbridge on August 11, 2009, at 22:23:06
In reply to Re: MAO's: why do doctors avoid them?, posted by CaptainAmerica1967 on August 11, 2009, at 21:23:25
Hey Captain,
Thanks for this link--I'm printing it out for the future if and when I have 'that' talk w/ my pdoc. The doubling of my pristiq isn't looking too promising--but I'm strapped in for the duration--10 more weeks! Maybe less...one can hope :)
fb
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