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Dr. Bob is Robert Hsiung, MD,
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Posted by jerseygal1 on June 22, 2011, at 17:08:52
In reply to Are MAOI's used when SSRI'S dont work?, posted by meAgain on June 22, 2011, at 15:05:46
MAOI's are still used if other meds haven't worked. My pdoc has suggested the possibility of trying an MAOI for me if we can't get another med to work. The thing about MAOI's is that you have to restrict certain things from your diet such as certain cheeses and meats, beer and wine, among other things. So I guess they are harder to use than other meds.
Posted by Christ_empowered on June 22, 2011, at 18:06:42
In reply to Re: Are MAOI's used when SSRI'S dont work?, posted by jerseygal1 on June 22, 2011, at 17:08:52
some docs are more willing to Rx MAOIs than others. I don't think its grounded in science so much as it is in the perception that MAOIs are old and potentially dangerous.
For OCD, there are other treatment strategies besides MAOIs. Antipsychotics, benzodiazepines, amphetamines, so on and so forth. Your doctor might want to try those first (again, there seems to be variability amongst docs on when, if ever, to go for the MAOIs.).
Posted by jms600 on June 22, 2011, at 18:24:12
In reply to Are MAOI's used when SSRI'S dont work?, posted by meAgain on June 22, 2011, at 15:05:46
> Are MAOI's used when SSRI'S dont work? Are they effective for depression or OCD or ADD? I just wonder why my doc has never prescribed one to me because She has seen how most SSRI's, SSNRI'S, and etc have not been too helpful..any thoughts?
I've spoke to numerous people on here, and MAOIs seem to be the gold standard for treating depression and anxiety. It's just that many docs won't prescribe them due to there side effects and associated dietary restrictions. I for one wish my doc would prescribe me some Nardil.
Parnate and Nardil seem to be the most well used of the MAOIs. Parnate is more stimulating while Nardil is better for depression which is accompanied by a lot of anxiety.
Posted by jono_in_adelaide on June 22, 2011, at 19:08:03
In reply to Are MAOI's used when SSRI'S dont work?, posted by meAgain on June 22, 2011, at 15:05:46
Generaly MAOI's are a last resort, when nothing else has worked.
Generaly you would have tried an SSRI, an SNRI, a noradrenalin reuptake inhibitor such as nortriptyline or another tricyclic, Welbutrin and Remeron before going onto an MAOI
They are generaly only prescribed by psychiatrists.
They can be amazingly effective for some people with depression, anxiety and OCD symptoms
If you have tried everything and had no sucsess, ask about trying one.
Posted by Phillipa on June 22, 2011, at 19:23:36
In reply to Re: Are MAOI's used when SSRI'S dont work?, posted by jono_in_adelaide on June 22, 2011, at 19:08:03
Today real life experience. We get our dog food at a health food store for animals. The older lady waiting on us seemed so happy I jokingly said are you on a happy pill. In reply she said that after the birth of her second child she had depression and finally after two years only meds available were Maoi's. She went on nardil said okay for depression but she said she had to go off due to inability to sleep and anxiety. Today she said she's a "lifer to ad's". Currently she said she has finally found a combo that works for her paxil and buspar. So real people have taken the maoi's. Phillipa
Posted by emmanuel98 on June 22, 2011, at 20:40:12
In reply to Re: Are MAOI's used when SSRI'S dont work?, posted by Phillipa on June 22, 2011, at 19:23:36
my p-doc (who is 72) said younger doctors are not being trained in how to use MAOIs. I did a two week washout from lexapro to try ensam (which didn't work for me), but the p-doc at the hospital I was in thought I needed a five-week washout. My p-doc came to the hospital and met with me and the p-doc there to straighten things out. My p-doc told me that when he was a resident, he studied at Charing Cross Hospital in London and they used MAOIs all the time. Now they are almost never prescribed. He was a resident in the late 1960s.
When I started on selegeline, I said maybe they don't prescribe these to suicidal patients because I could just eat some salami and cheese, wash it down with chiati and check out. The hospital p-doc and resident solemnly shook their heads, but my p-doc said it doesn't work that way. These are tendencies, not certainties. You have to have a few ounces of cheese to get into trouble.
So younger docs just don't know about MAOIs.
Posted by floatingbridge on June 23, 2011, at 0:50:05
In reply to Re: Are MAOI's used when SSRI'S dont work?, posted by emmanuel98 on June 22, 2011, at 20:40:12
Emmanuel, my (?) pdoc is maybe the same age (funny that I have never asked him) and he just about breaks into a sweat when I bring up any maoi. I really don't know why, and he was quite cross (it seemed) that I arm wrestled him for emsam.
My first cold call today (the doctor was very kind) asked me why I was interested
in a doctor who would consider maoi's. He paused, then asked why I wanted one. I explained briefly, and he then referred me to another doctor who, gosh, I don't think he said 'heavy' stuff, but maybe said something more like this doctor was a very solid guy.I felt the first doc was pretty upfront and
respectful. He said to try this other doc first, and I could come in to discuss pharmacology with him and possible treatments. I appreciate him not wasting my time by having me come in (whew!) and spent time asking questions. The other doc who I haven't heard from has
been in practice 45 years. That might place him near the generation of your doctor.My experience here is that asking for an maoi is like dropping a bomb. One doctor reccommended it once--younger,
maybe 40, at Stanford, but I blinked and my (?) pdoc just dug in his heels against it.I am asking him about his refusal directly this week. I want to know why. He has mentioned insomnia, but I have alwayd had insomnia; granted the insomnia from the emsam was far and away of a dfferent quality that I wonder if it changes the sleep architecture too greatly. That I could understand, since I have health issues. But if it doesn't flat
out wreck it beyond correction, I can't imagine the source of his aversion.I also have a call out to the second
referral.My trial of emsam was interfered with--started, then cut back to a third of a patch. When I retried a full patch, it didn't kick in, but that could be illusional. Since I took it off my arm last week my cognitive functioning is worsening.
Have you ever experienced a mental sharpening on any maoi (I have add), a mental clarity?
fb
Posted by emmanuel98 on June 23, 2011, at 19:37:04
In reply to Re: Are MAOI's used when SSRI'S dont work? » emmanuel98, posted by floatingbridge on June 23, 2011, at 0:50:05
Ensam didn't help me at all. My p-doc sent me to McLean and they wanted to start me on parnate. I've been on parnate for two years. It hasn't stabilized me completely. I've still had a couple of very bad bouts of depression and suicidality and been hospitalized twice. But when I went to McLean, I hadn't gotten out of bed for five weeks, hadn't showered, washed my hair, eaten. I was virtually catatonic. The parnate seems to keep me from getting back into that vegetative state.
Side effects: bad orthostatic hypotension which went away after a few months. Insomnia, for which I take ativan and trazadone. They work fine.
I don't understand why p-docs are so shy of MAOIs. They are not that dangerous. I eat small amounts of forbidden foods all the time with no problem. I wear a medical alert bracelet in case I have a car accident, so the anethesiologist doesn't give me demerol.
McLean was totally cool with MAOIs. I'm surprised Stanford was not.
Posted by floatingbridge on June 23, 2011, at 19:45:16
In reply to Re: Are MAOI's used when SSRI'S dont work?, posted by emmanuel98 on June 23, 2011, at 19:37:04
Your pdoc gives you trazdone with parnate? I read they were contraindicated. Good to hear that works.
Stanford recommended the maoi's. But that was a consult. My regular pdoc didn't want to. I'm not always very sure of myself or assertive. Plus, I was just scared. I really want my doc onboard with me. You probably understand.
I hope you are doing better.
Posted by emmanuel98 on June 23, 2011, at 20:23:09
In reply to Re: Are MAOI's used when SSRI'S dont work? » emmanuel98, posted by floatingbridge on June 23, 2011, at 19:45:16
I haven't had an issue with trazadone and parnate. But I don't understand your p-doc. You went for a consult. MAOIs were recommended, but he's not okay with that? Why not? He prescribed ensam, right? Above 6mg, ensam is just like any other MAOI, with all the dietary restrictions. But it only works on MAOI-B, while parnate and nardil work on A and B. I hope you find a new p-doc who can help. Older docs and docs associated with first tier teaching hospitals are most likely to be comfortable with MAOIs.
> Your pdoc gives you trazdone with parnate? I
read they were contraindicated. Good to hear that works.
>
> Stanford recommended the maoi's. But that was a consult. My regular pdoc didn't want to. I'm not always very sure of myself or assertive. Plus, I was just scared. I really want my doc onboard with me. You probably understand.
>
> I hope you are doing better.
Posted by floatingbridge on June 23, 2011, at 22:01:54
In reply to Re: Are MAOI's used when SSRI'S dont work?, posted by emmanuel98 on June 23, 2011, at 20:23:09
I don't understand either. He really hasn't been clear enough to me. Tomorrow I see him with my husband. I guess we'll formally decide the break. I hope he helps me transition. Jeez.
He cut the emsam back when my insomnia became more difficult in response to the emsam. That was my only sx besides a transient kinda' of head
pounding ramp up thing. I didn't want to be reduced. I didn't get it because I was having a mild positive response. Not like hallelujah, but I was getting out of bed, becoming more active though still very
fatigued. I didn't show any mania. So far that has never been an issue.I guess it's interpersonal. I am difficult,
but never hid that from anyone :-) That's why I see a psychiatrist. Unless he can really explain his reasoning, like a concern for my health or by suggesting a different course of treatment, I will need a different pdoc. I suppose that's pretty obvious to others, but he is also my therapist of three years.
Posted by floatingbridge on June 23, 2011, at 23:14:41
In reply to Re: Are MAOI's used when SSRI'S dont work?, posted by emmanuel98 on June 23, 2011, at 20:23:09
emmanuel, I just realized everything shifted in treatment when I began to experience physical pain. The fatigue became worse, like being unable to sit up on some days.
He began treating me differently. It's beyond me right now to bridge a gap. I would think that would be his responsibility as a therapist.
I've had so many things fall apart in my life--just like everyone.
I need to remember that if this falls
apart, it's not my fault. I have to remember to avoid blaming myself for everything. I can and will do better. Right now I feel like my brain is not working properly.I want to avoid another hospital visit. Imagine that. Other than that, it's hard to imagine anything.
I am pushing through this. I have calls out, I have some leads. Phone calls are so difficult for me. But I did them. I have appointments. I cleaned my kitchen and made molasses milk for my son. I did not cry anywhere near him.
Life is incredible. It's a frikkin' cliff-hanger. It's a blues song. Today I found out my lovely dog has cancer. He's 13, and we've been through thick and thin. I am not a neatnik by any means, but he's pretty clean for a dog. He sleeps in the bed.
Posted by Phillipa on June 23, 2011, at 23:41:07
In reply to Re: Are MAOI's used when SSRI'S dont work? » emmanuel98, posted by floatingbridge on June 23, 2011, at 23:14:41
Oh no your poor pup is it bad? Hoping not. Love Phillipa
Posted by emmanuel98 on June 24, 2011, at 18:57:11
In reply to Re: Are MAOI's used when SSRI'S dont work? » emmanuel98, posted by floatingbridge on June 23, 2011, at 23:14:41
> emmanuel, I just realized everything shifted in treatment when I began to experience physical pain. The fatigue became worse, like being unable to sit up on some days.
Odd. Maybe he thinks you are making it up or exagerrating the pain. Maybe he thinks you are seeking opiates. You should ask him this when you see him with your husband. But it seems you're going to have to look for someone else. To just cut you off like that when he was your T for three years! I have seen my p-doc for 6 years and still can't quite get by without him, even though I have another therapist I see for DBT. If he just cut me off, I'd freak.
Posted by floatingbridge on June 24, 2011, at 20:25:37
In reply to Re: Are MAOI's used when SSRI'S dont work?, posted by emmanuel98 on June 24, 2011, at 18:57:11
Well, I'm done with him. It's very stupidly complicated and utterly ridiculous. He thinks I have chronic ptsd and do not need medication, or maybe I do, but he's not sure what, but he made sure I look at the idea that I was at least psychologically addicted. Well, so? I am capable of looking at that, but if I ever get a brain again I will write an essay on the treatment of patients with anxiety
and phobia. He asked me if I knew why addicts became addicts and I just looked at him and said well I have quite alot to say about that, which I do, but we didn't even have time nor place for that.I felt like Alice at the tea party, only
because I kept repeating well, yes (or no, depending), BUT can you please help me sleep until the first week of July when I go to the clinic?It seems very thoughtless and cruel to withdraw all treatment from a person
who is suspected of having an 'anxiety disorder' who can become terrified at night. The absurdity was that he absolutely did not mean to be cruel.Thank goodness my husband was there to mediate. He said later, "you two don't
communicate very well." We laughed a little, but frankly, I'm shot to pieces now.I went to the urgent care (the walk in doctors) and they at least spoke to me
and gave me a trial of ambien an said to
call again on Sunday. It was a small comfort that someone in real life registered that I had a real need and that it was not wise practice to let someone begging for some medication to be untreated. The urgent care doctor made sure that I am not suicidal, and encouraged me to use the ER at night--I didn't need to be suicidal to go, and that someone would help me. He understood, using the term 'patch through' as in You want something to help you patch through to your next visit.That I have been reduced to begging feels very raw. I feel invisible, (not at the urgent care. I felt very real there,) and
that my pitiful refrain of 'help me sleep'
was some damning evidence I should
examine. I was told today that no one ever died of insomnia, that the body resets, blah-blah, and after a full two weeks off the emsam he could begin to
think of treatment options.The urgent care doctor was going to give
me xanax until I could see a primary doctor in the system, but I said, look, I
just, just went through the withdrawal window and am back to raw nerve. Let
me see if I can sleep. If I can't sleep by Sunday, I will come back.After three years, that he is only getting a
clue that I had life long insomnia and 'anxiety' and not maybe not depression feels pretty damn sh*tty. I certainly know far more about myself now--more than he does.I really do not think I will be trusting doctors again as both therapist and psychiatrist. This was way too much power and control for me in the long run. I don't extend that comment to your situation because for you it is working :-)
I am sorry to give you such an unedited reply. I am just really wrung out. I imagine I will be examining this experience for some time.
Thanks for listening.
Posted by Phillipa on June 24, 2011, at 21:52:20
In reply to Re: Are MAOI's used when SSRI'S dont work? » emmanuel98, posted by floatingbridge on June 24, 2011, at 20:25:37
FB if you didn't have ptsd you surely will now. But ambien? Only til Sunday. And if thinks anxiety and not depression doesn't that mean SSRI's or SNRI's just asking Love Phillipa
Posted by morgan miller on June 24, 2011, at 22:34:04
In reply to Are MAOI's used when SSRI'S dont work?, posted by meAgain on June 22, 2011, at 15:05:46
You said most SSRIs..What do your mean by most? What SSRIs have been tried?
Posted by floatingbridge on June 24, 2011, at 22:53:29
In reply to Re: Are MAOI's used when SSRI'S dont work? » floatingbridge, posted by Phillipa on June 24, 2011, at 21:52:20
Phillipa you just really made me laugh. OMG. I thank you. I haven't laughed in days. I just laughed again thinking about it. Yes, it's pretty silly.
Thank you.
:-)
Posted by floatingbridge on June 24, 2011, at 22:58:05
In reply to Re: Are MAOI's used when SSRI'S dont work?, posted by morgan miller on June 24, 2011, at 22:34:04
Meagain, I apologize for parking on this thread. I didn't mean too. :-/
> You said most SSRIs..What do your mean by most? What SSRIs have been tried?
Posted by zonked on June 24, 2011, at 22:59:12
In reply to Re: Are MAOI's used when SSRI'S dont work? » emmanuel98, posted by floatingbridge on June 24, 2011, at 20:25:37
I am so proud of you. Dumping your pdoc/therapist was hard, but even the urgent care has given you better assurance than he did--if I am understanding your posts correctly.
I know it was hard, but the guy just wasn't getting it. I am proud of you for being strong. I am glad the urgent care gave you assurance that they'll be there for you, should you need them.
Keep up the good work and keep us posted, hang in there, things will get better--
-z
Posted by emmanuel98 on June 25, 2011, at 0:33:29
In reply to Re: Are MAOI's used when SSRI'S dont work? » emmanuel98, posted by floatingbridge on June 24, 2011, at 20:25:37
When I first started parnate, I went 72 hours without sleep. It was awful. My p-doc finaly prescribed ativan after a lot of wrangling. First he prescribed seroquel and I came into his office after about three weeks and he said, you're gaining weight. You need to stop the seroquel. I hadn't even been weighing myself.
Posted by sigismund on June 25, 2011, at 15:13:49
In reply to Re: Are MAOI's used when SSRI'S dont work? » emmanuel98, posted by floatingbridge on June 23, 2011, at 0:50:05
>Have you ever experienced a mental sharpening on any maoi (I have add), a mental clarity?
FYI, people do report this with agomelatine.
Posted by Phillipa on June 25, 2011, at 19:30:50
In reply to Re: Are MAOI's used when SSRI'S dont work? » floatingbridge, posted by sigismund on June 25, 2011, at 15:13:49
I am getting notifications again from that board. So up and running again? PJ
Posted by sigismund on June 26, 2011, at 21:30:08
In reply to Re: Are MAOI's used when SSRI'S dont work? » sigismund, posted by Phillipa on June 25, 2011, at 19:30:50
Just not that much action on it, PJ, but some.
Posted by Phillipa on June 26, 2011, at 22:15:07
In reply to Re: Are MAOI's used when SSRI'S dont work? » Phillipa, posted by sigismund on June 26, 2011, at 21:30:08
Sigi what happened to M? Got his email address. And that guy Texas? Ever confirmed? PJ
This is the end of the thread.
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