Posted by TylerJ on April 1, 2006, at 14:49:56
In reply to Classical MAOIs, posted by ed_uk on April 1, 2006, at 14:01:38
> Hi Marty
>
> My opinion of Emsam is that it will be effective for some people but will not be comparable in efficacy (as an AD) to Nardil or Parnate.
>
> It is my hope that the introduction of Emsam will renew interest among psychiatrists in the classical MAOIs ie. Nardil and Parnate.
>
> It is my belief that most psychiatrists have little knowledge of MAOIs. They do not understand their indications, nor do they understand the MAOI diet, their drug interactions or side effects. Basically, they don't know anything about them. They may believe that MAOIs are 'dangerous' but will not appreciate the relative safety of MAOIs in experienced hands.
>
> MAOIs can be very effective treatments for severe depression and anxiety. It was once believed that MAOIs were less effective than the tricyclic ADs, this was the result of numerous trials which utilised very small (sub-therapeutic) doses of MAOIs. Unfortunately, many docs still believe this. Clearly, if MAOIs are to be effective, an adequate dose must be used. 45-90mg Nardil is commonly appropriate. The manufacturer of Parnate suggests 60mg as the maximum dose. In reality, some patients will require more - psychiatrists much realise this in order to gain the full potential of Parnate.
>
> In summary.....
>
> 1. Nardil and Parnate are effective medications for many types of depression and anxiety.
>
> 2. An knowledgeable psychiatrist in necessary to use MAOIs safely. MAOIs can be remarkably safe in experienced hands. Things start to go wrong when MAOIs are prescribed to ill-informed patients. A lot of education may be required. It's not a case of just handing over the prescription. Time and effort is required on the part of the prescribing psychiatrist.
>
> 3. Doctors like meds which are 'easy to prescribe' eg. fixed dose, little patient education or monitoring required.
>
> 4. Some doctors try ECT for depression before prescribing MAOIs. This is extremely depressing in itself. I guess it's quicker and easier to give someone an electric shock to the head than it is to spend time with a patient explaining how to take their MAOI safely. In addition, most pdocs are more knowledgeable about ECT than they are about MAOIs. ECT tends to provide short-term relief of depression, there is, however, a very high relapse rate. MAOIs provide a more realistic long term treatment.
>
> Ed
Good Job Ed. You definitely know your Psychopharmacology! What's best about you is that you have the ability to deliver your knowledge without a hint of arrogance. I for one can appreciate that. :}Tyler
poster:TylerJ
thread:627408
URL: http://www.dr-bob.org/babble/20060329/msgs/627529.html