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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by Roslynn on October 18, 2018, at 13:46:52
Hey guys,
Stupid question...my pdoc retired and I'm having a hard time finding one who takes Medicare. The one I found who has available appointments is not familiar with the MAOIs, but I take Parnate.
He said he would prescribe it for me since I'm already on it. I know this is not a great idea, but is it possible to have this doc treat me even though he's unfamiliar with my med?
Anyone else have this happen?
Thank you for any replies,
~Roslynn
Posted by beckett2 on October 19, 2018, at 0:55:51
In reply to I take Parnate, new doc unfamiliar with MAOIs???, posted by Roslynn on October 18, 2018, at 13:46:52
That's not a stupid question. I think it's pretty important. Hopefully someone w/ experience will comment. I just wanted to say hi and wish you luck.
Posted by PeterMartin on October 19, 2018, at 2:10:02
In reply to I take Parnate, new doc unfamiliar with MAOIs???, posted by Roslynn on October 18, 2018, at 13:46:52
I went through a similar situation when my pdoc retired at the end of last year.
Honestly I think you've done the hardest part which is to get in with a doctor who will continue to prescribe you Parnate (MAOI). I was afraid that even though I'd been on Marplan successfully for 7yrs any new/younger doctor might not be comfortable continuing me on it. It's difficult to call in advance and ask if a doctor would or would not prescribe an MAOI w/o sounding like you're drug seeking.
So in my view you're fortunate (as I was) to find another doctor to keep you on your current meds. It's true he's not familiar w/ it but everyone reacts different to all types of medicines. A lot of the suggestions will be the same. If you feel worse or have hypertension issues...lower the dose. If you keep getting depressed maybe it's time to try something else.
There really isn't that much unique about MAOI treatment so long as you're aware of what you should and shouldn't be taking. Like if he suggests adding any additional medicines I'd definitely search here and check an interaction checker just to be safe....
Just my pov but a much worse problem would be to have to come off Parnate (granted it's working) because you couldn't find a doctor willing to prescribe it.
Posted by Christ_empowered on October 19, 2018, at 2:11:50
In reply to Re: I take Parnate, new doc unfamiliar with MAOIs??? » Roslynn, posted by beckett2 on October 19, 2018, at 0:55:51
I wish I had an actual answer. I've never taken an MAOI. these are serious drugs...so I would think the ideal would be a psychiatrist who is familiar with them and will keep an eye out. But then again...
not to sound bitter, but as I look over my "past treatment history," I've got to wonder...when did the psychiatrists ever keep an eye out, or even...well...earn their fee?
labs are handled by the family doctor. oh, you want to try metformin? ask your family doctor. oh, you want to talk? you know, we have counselors at this practice.
oh...my personal favorite, thus so far: "why, I think I've seen 1 case of tardive dyskinesia in my entire career...caused by Mellaril, I believe it was..." its my favorite because the psychiatrist in question has been in practice since the early 1960s, mostly in state-funded facilities...
lies, lies, lies.
i don't know what else you're taking, but...have you considered a switch to more modern, less potentially toxic combinations? "California Rocket Fuel" comes to mind, maybe with an upper in the mix or something. I don't know, honestly...i do hope it gets better for you. speaking of uppers...a lot of what Parnate's all about is stimulation, right? have you tried a stimulant for your depression? maybe with a benzodiazepine or another sort of sedative in the mix, at the same time (its the ole goof ball approach, and it can work for some people...) ?
sorry to throw all these questions your way, along with my own war stories...-If- it was me, I'd try to work with a decent psychiatrist to get off the Parnate and onto something that would target my problems and maybe even make me feel good every now and then, without having to watch the food and drug intake, etc.
I'm into Orthomolecular psychiatry. Dr.Hoffer, the Big Man of this form of psychiatry, spoke highly of Anafranil for depression. just a thought...its not the easiest thing to tolerate, but I imagine it'd be easier than dealing with a potentially dangerous drug and an under-informed psychiatrist.
sorry to go on and on. hope this helps.
Posted by Roslynn on October 19, 2018, at 14:04:33
In reply to Re: I take Parnate, new doc unfamiliar with MAOIs??? » Roslynn, posted by beckett2 on October 19, 2018, at 0:55:51
> That's not a stupid question. I think it's pretty important. Hopefully someone w/ experience will comment. I just wanted to say hi and wish you luck.
Hi beckett2, thank you!
Posted by Roslynn on October 19, 2018, at 14:15:34
In reply to Re: I take Parnate, new doc unfamiliar with MAOIs???, posted by PeterMartin on October 19, 2018, at 2:10:02
> I went through a similar situation when my pdoc retired at the end of last year.
>
Hi Peter, thank you for your reply :)> Honestly I think you've done the hardest part which is to get in with a doctor who will continue to prescribe you Parnate (MAOI). I was afraid that even though I'd been on Marplan successfully for 7yrs any new/younger doctor might not be comfortable continuing me on it. It's difficult to call in advance and ask if a doctor would or would not prescribe an MAOI w/o sounding like you're drug seeking.
Yes, he said as long as I was familiar with the food/drug interactions, he could prescribe it.
>
> So in my view you're fortunate (as I was) to find another doctor to keep you on your current meds. It's true he's not familiar w/ it but everyone reacts different to all types of medicines. A lot of the suggestions will be the same. If you feel worse or have hypertension issues...lower the dose. If you keep getting depressed maybe it's time to try something else.
>
> There really isn't that much unique about MAOI treatment so long as you're aware of what you should and shouldn't be taking. Like if he suggests adding any additional medicines I'd definitely search here and check an interaction checker just to be safe....
>
> Just my pov but a much worse problem would be to have to come off Parnate (granted it's working) because you couldn't find a doctor willing to prescribe it.One of my only concerns, and I should have mentioned this in my original post, is that I'm still in the beginning stages of taking the Parnate because I'm increasing the dose extremely slowly. So I'm still titrating upwards. I wonder if he'll be able to help me with dosing at all? What if in the worst-case scenario I needed to withdraw from it? (I mean, I don't expect to but you never know.)
Thank you for your help, I really appreciate it!
~Roslynn
Posted by Roslynn on October 19, 2018, at 14:23:30
In reply to Re: I take Parnate, new doc unfamiliar with MAOIs???, posted by Christ_empowered on October 19, 2018, at 2:11:50
> I wish I had an actual answer. I've never taken an MAOI. these are serious drugs...so I would think the ideal would be a psychiatrist who is familiar with them and will keep an eye out. But then again...
Hi, I know that would be the best. There is no one around here...
> not to sound bitter, but as I look over my "past treatment history," I've got to wonder...when did the psychiatrists ever keep an eye out, or even...well...earn their fee?
>
> labs are handled by the family doctor. oh, you want to try metformin? ask your family doctor. oh, you want to talk? you know, we have counselors at this practice.
>>
>
> i don't know what else you're taking, but...have you considered a switch to more modern, less potentially toxic combinations? "California Rocket Fuel" comes to mind, maybe with an upper in the mix or something. I don't know, honestly...Yes, I did try that combo, no luck. I actually lost weight, which was bizarre...
>
> i do hope it gets better for you. speaking of uppers...a lot of what Parnate's all about is stimulation, right? have you tried a stimulant for your depression? maybe with a benzodiazepine or another sort of sedative in the mix, at the same time (its the ole goof ball approach, and it can work for some people...) ?
>Yeah, the Parnate is actually sedating for me right now but I'm at a low dose. We'll see what happens..
> sorry to throw all these questions your way, along with my own war stories...
>
> -If- it was me, I'd try to work with a decent psychiatrist to get off the Parnate and onto something that would target my problems and maybe even make me feel good every now and then, without having to watch the food and drug intake, etc.
>
> I'm into Orthomolecular psychiatry. Dr.Hoffer, the Big Man of this form of psychiatry, spoke highly of Anafranil for depression. just a thought...its not the easiest thing to tolerate, but I imagine it'd be easier than dealing with a potentially dangerous drug and an under-informed psychiatrist.
>
> sorry to go on and on. hope this helps.
>
> I was on anafranil for a really long time and it did help for a while. Thank you for all your suggestions! I really appreciate it.~Roslynn
>
>
>
Posted by baseball55 on October 21, 2018, at 18:16:49
In reply to I take Parnate, new doc unfamiliar with MAOIs???, posted by Roslynn on October 18, 2018, at 13:46:52
> Hey guys,
>
> Stupid question...my pdoc retired and I'm having a hard time finding one who takes Medicare. The one I found who has available appointments is not familiar with the MAOIs, but I take Parnate.
>
> He said he would prescribe it for me since I'm already on it. I know this is not a great idea, but is it possible to have this doc treat me even though he's unfamiliar with my med?
>
> Anyone else have this happen?
>
I would expect that your new doc will educate himself about parnate and you can educate him as well. Some p-docs are scared of MAOIs because of drug and food interactions. But they are not as scary as they are made out to be. What is there to know? No SSRIs. No demerol (which nobody uses anymore) or tramadol. Inform anesthesiologist before any surgery. Careful with dried or aged meats or cheeses or fermented foods. Two-week washout before or after using an SSRI or another MAOI.Insomnia can be a side effect, though you say you find parnate sedating. Postural hypotension can be a side effect, so you need to take care when rising from a lying or sitting position. As with TCA's, dry mouth is a common side effect. Carry a bottle of water around with you.
Other than that, they are safe (no dangers if you overdose, unlike TCA's or SSRI's), effective, and when they work they tend to work fast.
I have been on parnate for 8 years and, for the most part, done pretty well on it. Occasional problems with depression but nowhere near the prior problems of not being able to function for months on end, repeated hospitalizations, etc. At the beginning, I had terrible insomnia, for which I took a benzo and I nearly fell a couple of times when I got up in the middle of the night to pee and forgot to stand and hold on to something for a couple of minutes, till my BP stabilized.
> ~Roslynn
Posted by Roslynn on October 22, 2018, at 18:32:14
In reply to Re: I take Parnate, new doc unfamiliar with MAOIs???, posted by baseball55 on October 21, 2018, at 18:16:49
> >
> I would expect that your new doc will educate himself about parnate and you can educate him as well. Some p-docs are scared of MAOIs because of drug and food interactions. But they are not as scary as they are made out to be. What is there to know? No SSRIs. No demerol (which nobody uses anymore) or tramadol. Inform anesthesiologist before any surgery. Careful with dried or aged meats or cheeses or fermented foods. Two-week washout before or after using an SSRI or another MAOI.
>
> Insomnia can be a side effect, though you say you find parnate sedating. Postural hypotension can be a side effect, so you need to take care when rising from a lying or sitting position. As with TCA's, dry mouth is a common side effect. Carry a bottle of water around with you.
>
> Other than that, they are safe (no dangers if you overdose, unlike TCA's or SSRI's), effective, and when they work they tend to work fast.
>
> I have been on parnate for 8 years and, for the most part, done pretty well on it. Occasional problems with depression but nowhere near the prior problems of not being able to function for months on end, repeated hospitalizations, etc. At the beginning, I had terrible insomnia, for which I took a benzo and I nearly fell a couple of times when I got up in the middle of the night to pee and forgot to stand and hold on to something for a couple of minutes, till my BP stabilized.
>baseball55,
Thank you so much for your feedback...I really appreciate it. And the fact that you take Parnate (and you know what you're talking about) is reassuring to me. So maybe this won't be such a terrible thing, as you said the doc can educate himself and I'm already aware myself of the med/food interactions.
Thanks again,
Roslynn
This is the end of the thread.
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