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Dr. Bob is Robert Hsiung, MD,
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Posted by Quintal on January 4, 2007, at 9:46:26
In reply to Re: Are MAOIs worth it?, posted by djmmm on January 4, 2007, at 9:10:52
>A lot of the physical effects of what you may attribute to an amphetamine metabolite, may simply be the result of a spike in blood pressure, or the catecholamine enhancing effects of Parnate itself.
Parnate certainly did increase my heart rate after each dose.
>Im guessing, the amount of Amphetamine/Methamphetamine derived as a metabolite, would have to be VERY high to elicit a "meth-like" response (thus the reported presense of amphetamine metabolites in overdose)
Even small amounts of methamphetamine/phenethylamine produced as metabolites could elicit a powerful response when MAO inhibition is high (as it is likely to be in people taking very high doses of Parnate) due to the synergistic sympathomimetic effect. I'm not aware of any studies giving precise data on the amounts of these metabolites but I will have a look.
This has been discussed at length on PB but I don't recall a definite conclusion. Maybe some of the older members will be able to add some insight? Parnate certainly feels like a powerful stimulant at high doses for many people whatever the underlying pharmacology may be.
Q
Posted by Karen44 on January 4, 2007, at 19:54:58
In reply to Re: Are MAOIs worth it? » Karen44, posted by Quintal on January 4, 2007, at 0:45:27
> >Parnate has amphetamine-like qualities.
>
> The old Parnate methamphetamine metabolite debate? There's still much confusion over that but I found Parnate did have an amphetamine-like feel to it at high doses. Amphetamine metabolites have been found in the blood and urine of Parnate overdoses and people have posted here to say they have tested positive for amphetamines while taking Parnate.
>
> At 120mg I had the dilated pupils, racing heart, erect nipples and gooseflesh characteristic of 'crystal meth'. I wonder if going back to it would help my fatigue?
>
> Q
Wow Q, I never took such a high dose of Parnate when I was on it. The most I was ever prescribed was 40 mg. I guess I am surprised that someone would prescribe such a high dose.After I had been on Parnate for a time and after I went back to graduate school, I researched about Parnate for my Psychopharmacology class. It certainly was energizing for me, and when I tried to split the dose and take half at night, I was too wound up.
Karen44
Posted by laima on January 4, 2007, at 20:22:58
In reply to Re: Are MAOIs worth it? » Quintal, posted by Karen44 on January 4, 2007, at 19:54:58
How socially awkward is following a strict MAOI diet? Is it a huge deal at restaurants, parties, going out for a drink... What does one say to acquaintences about it, without launching into a description of a mood disorder and obscure, severe-sounding medication? Do people feel deprived, or live in fear of food? Or get used to it?
Posted by Karen44 on January 4, 2007, at 23:26:21
In reply to Re: Are MAOIs worth it?, posted by laima on January 4, 2007, at 20:22:58
>
> How socially awkward is following a strict MAOI diet? Is it a huge deal at restaurants, parties, going out for a drink... What does one say to acquaintences about it, without launching into a description of a mood disorder and obscure, severe-sounding medication? Do people feel deprived, or live in fear of food? Or get used to it?I used to tell people I was taking a medication that would cause me to get sick if I ate cheeses, etc. I don't recall anyone why, and I don't remember anyone asking. I guess I would just say I have an imbalance that means I have to take this medication for the time being.
Karen44
Posted by jedi on January 4, 2007, at 23:37:35
In reply to Re: Are MAOIs worth it?, posted by laima on January 4, 2007, at 20:22:58
It is really no big deal for me, and I have been on Nardil for most of the past 10 years. I'll order a bottled Bud Light instead of the micro brews on tap (any tyramine excess is in the tap, not the beer). In a Mexican Restaurant I tell the waiter I can't eat cheddar and please use mozzeralla, no questions asked. There are really very few foods that I can't eat, but you would not call mine a strict MAOI diet. Most high tyramine foods like sauerkraut and liver, I don't like anyway. The only thing I really miss is aged cheeses. I use the MAOI diet short list posted by Elizabeth in 2001. Has any one heard anything of her in the past few years? I sure hope she went on to get well.
Link: http://www.dr-bob.org/babble/20010814/msgs/75408.htmlOf course, what works for me will not work for everybody. Baring some miracle of modern science, I will be on MAOIs for the rest of my life. The diet thing is really not that big of deal, when compared to the alternative of life threatening depression.
Take care,
Jedi
> How socially awkward is following a strict MAOI diet? Is it a huge deal at restaurants, parties, going out for a drink... What does one say to acquaintences about it, without launching into a description of a mood disorder and obscure, severe-sounding medication? Do people feel deprived, or live in fear of food? Or get used to it?
Posted by laima on January 5, 2007, at 8:08:29
In reply to Re: Are MAOIs worth it? » laima, posted by jedi on January 4, 2007, at 23:37:35
Thanks- so it sounds like one can make the diet into not such a major to-do, socially. That's good to know. We'll see now if I end up on a new MAOI (other than Emsam) or not.
Posted by tessellated on January 5, 2007, at 15:59:40
In reply to Re: Are MAOIs worth it? » Karen44, posted by Quintal on January 4, 2007, at 0:45:27
-people have posted here to say they have tested positive for amphetamines while taking Parnate.
i was one of those peeps.
david pearce puts it pretty well on the biopsychiatry.com site. i would say the non-selective MAOI's are not for the mild dysphoria. not because of SE's, but because of the profound alteration of one's chemistry.
to me nothing ever has quite felt like a lock and key solution.
they were as close to a near reversal of depression as anything i've experienced.only they metabolise strangely. working on cytokines as well, so both dosing schedule and amount are tricky. if there was a parnate SR or something i'd go back. i also suffered from either fatigue or borderline manic insomnia, with great moments tween. 100mg parnate and up turned me into something of a kinder gentler version of a dr.jeckyl. fun. but a little wild.
I had an amazing psychopharmacologist who categorized parnate and provigil as "smart drugs", and i agree. they are options to try prior to more potent stims and vastly less problematic.
Achieving a sustainable "golden mean" is a problem in general, but i think i've had the longest glimpses of it with MAOI's.
l8
> Q
Posted by tessellated on January 5, 2007, at 16:04:39
In reply to Re: Are MAOIs worth it?, posted by laima on January 5, 2007, at 8:08:29
re: diet
i ate practically everything on the not to list and never had a problem with hypertension only hypotension. i think there is a vast difference across populations.
Posted by deuce224 on January 6, 2007, at 2:55:58
In reply to Re: Are MAOIs worth it?, posted by NYCguy on January 2, 2007, at 19:18:37
i Have been on parnate for 9 months now and the only restrictions i have had in my diet were cheese related. slowly I learned that i could eat mozzarella no problem and have started eating small amounts of other cheeses. The key is to eat a small amount and then check your blood pressure. So basically the diet really isn't a problem.-joe
Posted by naughtypuppy on January 6, 2007, at 10:36:34
In reply to Re: Are MAOIs worth it?, posted by tessellated on January 5, 2007, at 16:04:39
I ate pretty well anything I wanted on Nardil. I had to be a little more careful with Parnate. The hypotension was the real problem.
Posted by tensor on January 6, 2007, at 13:08:43
In reply to Re: Are MAOIs worth it?, posted by naughtypuppy on January 6, 2007, at 10:36:34
You who took or are taking an MAOI, are you given an antidote for hypertensive crisis like nifedipine to carry with you all the time (syringe/pill)? I mean, sometimes you can be pretty far from a hospital. How do you know when the blood pressure is getting dangerously high?
/Mattias
Posted by Quintal on January 6, 2007, at 13:34:55
In reply to Re: Are MAOIs worth it?, posted by tensor on January 6, 2007, at 13:08:43
>You who took or are taking an MAOI, are you given an antidote for hypertensive crisis like nifedipine to carry with you all the time (syringe/pill)? I mean, sometimes you can be pretty far from a hospital. How do you know when the blood pressure is getting dangerously high?
No, not in the UK. I asked for a packet of sublingual nifedipine tablets from my pdoc but he refused. He seemed to think it was an overly melodramatic gesture. I bought a reasonably priced self-inflating blood pressure cuff to check my own blood pressure.
Q
Posted by Quintal on January 6, 2007, at 13:38:35
In reply to Re: Are MAOIs worth it? » Quintal, posted by Karen44 on January 4, 2007, at 19:54:58
>Wow Q, I never took such a high dose of Parnate when I was on it. The most I was ever prescribed was 40 mg. I guess I am surprised that someone would prescribe such a high dose.
My pdoc refused to raise the dose above 30mg and was hoping to reduce it to 10mg after a few months. I found doses below 30mg made me feel even more anxious and suicidal so I raised it myself after reading comments by people posting here. I found Parnate was most effective in the 80-120mg range but obviously I kept running out of tablets and couldn't find a website that sold it online.Q
Posted by Karen44 on January 6, 2007, at 15:52:11
In reply to Re: Are MAOIs worth it? » Karen44, posted by Quintal on January 6, 2007, at 13:38:35
> >Wow Q, I never took such a high dose of Parnate when I was on it. The most I was ever prescribed was 40 mg. I guess I am surprised that someone would prescribe such a high dose.
>
>
> My pdoc refused to raise the dose above 30mg and was hoping to reduce it to 10mg after a few months. I found doses below 30mg made me feel even more anxious and suicidal so I raised it myself after reading comments by people posting here. I found Parnate was most effective in the 80-120mg range but obviously I kept running out of tablets and couldn't find a website that sold it online.
>
> Qno wonder the symptoms; you could have killed yourself with such a high dose. I am not sure what might be the highest dose one could be prescribed, but I think my pdoc was willing to go up to 60 mg.
Karen44
Posted by Quintal on January 6, 2007, at 16:01:47
In reply to Re: Are MAOIs worth it? » Quintal, posted by Karen44 on January 6, 2007, at 15:52:11
>no wonder the symptoms; you could have killed yourself with such a high dose
Why do you think that? Most people who have taken Parnate long term on PB were taking doses higher than 60mg. Here's a quote from Wikipedia that supports the idea that high doses are safe:
__________________________________________________Doses of up to 750mg/day have been administered for up to 1 year without adverse effects, and doses up to 200mg/day have been administered for decades, giving tranylcypromine a wide safety margin.
http://en.wikipedia.org/wiki/Parnate
__________________________________________________The symptoms were actually very enjoyable - that's why I took such large doses.
Q
Posted by tessellated on January 7, 2007, at 2:58:58
In reply to Re: Are MAOIs worth it? » Karen44, posted by Quintal on January 6, 2007, at 16:01:47
yes, i only found doses over 100mg effective.
but somewhere between 100-200mg/24hr also iduced mania.
i think it begins to have a compounding or exponentially stimulating effect at that point. and personally, i only experienced hypotension at higher doses.personally i know (for myself) hypertension and diet were at the bottom of the list of concerns. insomnia and mania were the greatest problems.
Posted by deuce224 on January 7, 2007, at 14:14:00
In reply to Re: Are MAOIs worth it?, posted by tensor on January 6, 2007, at 13:08:43
> You who took or are taking an MAOI, are you given an antidote for hypertensive crisis like nifedipine to carry with you all the time (syringe/pill)? I mean, sometimes you can be pretty far from a hospital. How do you know when the blood pressure is getting dangerously high?
>
> /MattiasYou can ask for those meds for hypertensive crisis, but i didn't and my doctor didn't recommend it. I think it is blown out of proportion and I have honestly never had a problem with high blood pressure.-joe
Posted by Karen44 on January 7, 2007, at 23:38:32
In reply to Re: Are MAOIs worth it? » Karen44, posted by Quintal on January 6, 2007, at 16:01:47
> >no wonder the symptoms; you could have killed yourself with such a high dose
>
> Why do you think that? Most people who have taken Parnate long term on PB were taking doses higher than 60mg. Here's a quote from Wikipedia that supports the idea that high doses are safe:
> __________________________________________________
>
> Doses of up to 750mg/day have been administered for up to 1 year without adverse effects, and doses up to 200mg/day have been administered for decades, giving tranylcypromine a wide safety margin.
> http://en.wikipedia.org/wiki/Parnate
> __________________________________________________
>
> The symptoms were actually very enjoyable - that's why I took such large doses.
>
> Q_________________________________________________
I just never heard of someone taking such a high dose, and it sounds like your reaction to the high dose was more like it serving to allow you to be like someone strung out on amphetamines rather than it serving as an antidepressant.
Karen44
Posted by CrimsonVik on January 8, 2007, at 3:47:09
In reply to Are MAOIs worth it?, posted by UgottaHaveHope on January 2, 2007, at 18:10:34
Miracle drug? Nope. There's a reason you hardly hear anything about them, and it's not just the side-effects. I wish my Dr. had never mentioned an Maoi, but now I dread a 10 day to 2 week washout.
I've have 3 kinds now.
Red
> Are MAOIs worth all the restrictions? When you take them, do they feel very different than SSRIs? How? Are they a miracle drug? Michael
Posted by leo33 on January 9, 2007, at 14:46:40
In reply to Re: Are MAOIs worth it?, posted by tessellated on January 5, 2007, at 16:04:39
I had hypertensive reactions to balsalmic vinegar and tylenol when I was on Nardil. Tried to kill myself when withdrawaling from it though, so be aware they can have nasty withdrawal effects.
Posted by Quintal on January 9, 2007, at 16:03:39
In reply to Re: Are MAOIs worth it?, posted by leo33 on January 9, 2007, at 14:46:40
>I had hypertensive reactions to balsalmic vinegar and tylenol when I was on Nardil.
I don't know about balsamic vinegar but there are no reported hypertensive crises to plain paracetamol/acetaminophen (Tylenol) and MAOIs. I took it myself often while taking Parnate and had no problems. Some people do develop hypertension after taking Tylenol and other OTC painkillers, maybe that's what you were observing rather than a mild hypertensive crisis?
http://www.webmd.com/content/article/53/50447.htm
>Tried to kill myself when withdrawaling from it though, so be aware they can have nasty withdrawal effects.
They certainly can - it's advisable to have at least a benzo at hand during MAOI withdrawal.
Q
Posted by naughtypuppy on January 10, 2007, at 9:57:22
In reply to Re: Are MAOIs worth it? » leo33, posted by Quintal on January 9, 2007, at 16:03:39
> >I had hypertensive reactions to balsalmic vinegar and tylenol when I was on Nardil.
>
> I don't know about balsamic vinegar but there are no reported hypertensive crises to plain paracetamol/acetaminophen (Tylenol) and MAOIs. I took it myself often while taking Parnate and had no problems. Some people do develop hypertension after taking Tylenol and other OTC painkillers, maybe that's what you were observing rather than a mild hypertensive crisis?
>
> http://www.webmd.com/content/article/53/50447.htm
>
> >Tried to kill myself when withdrawaling from it though, so be aware they can have nasty withdrawal effects.
>
> They certainly can - it's advisable to have at least a benzo at hand during MAOI withdrawal.
>
> QI'll second that. Nardil withdrwal can be pretty miserable.
Posted by leo33 on January 11, 2007, at 0:06:21
In reply to Re: Are MAOIs worth it?, posted by naughtypuppy on January 10, 2007, at 9:57:22
Well I can tell you I had one, maybe it was a tylenol cold flu or something, did not really check this was back in 1993 and had headache already so a girl gave me a tylenol something. Got pounding head, nausea, dizziness, difficulty breathing, i just went outside and had to walk around for a long time, i could not stop because symptoms got worse. I did not go to hospital either time as I was not sure what was happening, did not really know about the hypertensive crisis thing then. It eventually went away but came on extremely quick.
They did not offer me a benzo during withdrawal and i was withdrawaling in an intensive outpatient setting. Thats all I can tell you.
Posted by Quintal on January 11, 2007, at 0:35:37
In reply to Re: Are MAOIs worth it?, posted by leo33 on January 11, 2007, at 0:06:21
>Well I can tell you I had one, maybe it was a tylenol cold flu or something
That sounds very likely - it was probably one of those compound preparations containing a decongestant and caffeine.
Q
Posted by RN320 on January 12, 2007, at 13:38:16
In reply to Are MAOIs worth it?, posted by UgottaHaveHope on January 2, 2007, at 18:10:34
Hi Michael-
I'm on EMSAM (12mg), and consider myself to be a success story. I have been able to overcome the problems with orthostatic hypotension. the dietary restrictions are really important with the MAOIs. It's supposed to be more relaxed than with the oral forms, but I'm really careful wbout what I eat. You asked about what people do if they have a hypertensive crisis...... I just had one a week ago (my first and hopefully last) when I ate some really wonderful Thai food that the cook and manager promised me had no soy or MSG, or fermented products. Anyway, about 15-20 minutes after I finished eating, I had a severe reaction come on like a hammer with a blinding headache. I was in my car on the way home, and had to pull over because I couldn't see well enough to drive and my heart was racing and the arteries in my neck were sticking out and pulsating, so I knew what was happening. I didn't really know what to do. My pdoc had said that because I'm "overly careful" about my diet that I shouldn't worry about it happening. If he told me something beyond that, i didn't remember. Anyway, I had baby aspirin in my purse, so I immediately chewed 4 or 5 of them (everyone should really carry them if you're middle aged and at risk for a stroke and/or heart attack- it can really save your life). Then the only thing that I could think of was to take some nitroglycerin under my tongue, since it brings your pressure down fast. (I have these by prescription for heart disease.) I took 3 of these a few minutes apart and I could feel my BP coming down and headache dimishing to the point where I could drive. When I got home, I immediately took my BP and it was 176/98 (I normally run 100/60) so only God knows how high it as when I was in my car. It continued to decrease as i took it every half hour for about 4 hours. My pdoc was really stunned, and is in the process of writing a "medical letter" to BMS and the FDA about it, since clearly I could have died. He said that I did exactly the right thing. I had heard that many pdocs used to give a script for "emergency" labetalol, which is a pretty powerful antihypertensive and works quickly. But you're really not supposed to give this with an MAOI, so some now use procardia (gelcaps) and they have people bit them, squirt the contents under their tongue and then swallow it. It is a very effective way to quickly reduce someone's BP.I really don't mean to scare you by telling you this. I guess what I'm trying to say is that I've been able to work around or manage everything that has come up. Sure, I miss using Afrin when I have a cold, and I really really miss cheese- but I am so much better on the EMSAM that I'll do just about anything to stay on it. It would seem to reason that if you're on a drug that finally works for you after so many other failures, you will need to be vigilant about managing restrictions and potential side effects and adverse reactions. To me, there's just something about having a quality of life again!
Best wishes to you.
/m
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