![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 25 of 80. This is the beginning of the thread.
Posted by Uncouth on July 20, 2015, at 10:20:26
So I am having major sleep apnea surgery August 20th. I have asked my surgeon to check with anesthesiologist with respect to which medications I need to stop and what I can stay on.
Unfortunately he has stated that I need to stop my 120mg tranylcypromine two weeks before surgery. I am quite worried as years ago when I stopped an MAOI I fell into an ECT resistant depression (though was in much worse general shape then, and recovery from sleep apnea surgery will include hydrocodone).
In any event, if I can't get the anesthesiologist to let me remain on MAOI, what would be the best tapering protocol over the next month to reduce the chance of mood disturbance.
I am worried, but am also on other medications that hopefully will help "pick up the slack":
Ability 2mg
Strattera 100mg
Namenda XR 21mg
Parnate 120mg (need to taper off)Anyone have any experience with tapering off of high dose MAOI? I am frustrated as it took a long time to work up to this dose and I feel like it just started to kick in. What will I expect?
Posted by SLS on July 20, 2015, at 12:59:21
In reply to Stopping Parnate for surgery? Help!, posted by Uncouth on July 20, 2015, at 10:20:26
According to my cursory research, the following anesthesia drugs are compatible with MAOIs. At the very least, your anesthesiologist should research combining propofol with midazolam.
- Scott--------------------------------------------
alfentanil
atracurium
codeine
fentanyl
hydrocodone
hydromorphone
ketamine
ketorolac
midazolam
mivacurium
morphine
oxycodone
phenelphrine
propofol
rapacuronium
remifentanil
sufentanil
vecuronium
Posted by SLS on July 20, 2015, at 13:34:53
In reply to Re: Stopping Parnate for surgery? Help! » Uncouth, posted by SLS on July 20, 2015, at 12:59:21
Despite having a list to wave in front of an anesthesiologist, if I were him, I would still be scared to stake my career on it. You need to start coming off of Parnate now. You need time to taper. Coming off of Parnate will probably leave you with a great deal of fatigue, with or without depression. What about reducing the dosage of Parnate by 20 mg/day every 5 days?
- Scott
Posted by Robert_Burton_1621 on July 20, 2015, at 14:11:11
In reply to Re: Stopping Parnate for surgery? Help! » Uncouth, posted by SLS on July 20, 2015, at 12:59:21
> According to my cursory research, the following anesthesia drugs are compatible with MAOIs. At the very least, your anesthesiologist should research combining propofol with midazolam.
>
>
> - Scott
>
> --------------------------------------------
>
> alfentanil
> atracurium
> codeine
> fentanyl
> hydrocodone
> hydromorphone
> ketamine
> ketorolac
> midazolam
> mivacurium
> morphine
> oxycodone
> phenelphrine
> propofol
> rapacuronium
> remifentanil
> sufentanil
> vecuronium
>Also, my search brought up:
felypressin (octopressin)
buprenorphine
benzodiazepineStahl states (2012 CNS Spect 17.1) that fentanyl is strictly prohibited. Gillman (2005 Brit J Anaesthesia 95.4) concludes that it has "possibly" caused fatalities from serotonin toxicity.
Obviously care must be taken with anesthesia, but I agree with Scott in his advice to suggest that your anesthetist research the possibility of your remaining on parnate. Apparently dangers with anesthesia are the indirectly acting sympatho-mimetic agents which are hardly ever used therapeutically now anyway, and medications which can induce serotonin syndrome like pethadine and tramadol. There used to be something like a default assumption that MAOIs cannot be taken simultanously with anaesthetics. I say "used to be" but what I mean is that many doctors - and psychiatrists - remain burdened by this misapprenehsion. A psychiatrist I saw in 2014 asserted, on my broaching the subject of MAOIs, confidently and without any qualification, that if I were to take MAOIs I would not be able to have any surgery or dental work for the next five years (his estimation of how long I needed treatment).
There have been significant advances in the understanding of MAOIs and interactions. Here's some recent links (their suggestions may be contained in the list Scott produces):
http://bja.oxfordjournals.org/content/95/4/434.full
http://www.ncbi.nlm.nih.gov/pubmed/22938842
http://www.ncbi.nlm.nih.gov/pubmed/23993253
Posted by Robert_Burton_1621 on July 20, 2015, at 14:36:06
In reply to Re: Stopping Parnate for surgery? Help!, posted by SLS on July 20, 2015, at 13:34:53
> Despite having a list to wave in front of an anesthesiologist, if I were him, I would still be scared to stake my career on it. You need to start coming off of Parnate now. You need time to taper. Coming off of Parnate will probably leave you with a great deal of fatigue, with or without depression. What about reducing the dosage of Parnate by 20 mg/day every 5 days?
>
>
> - ScottSorry, didn't catch this supplementary comment before posting.
Uncouth, I would be inclined to emphasise to your treating doctor your psychiatric vulnerability - in particular your previous experience of ECT resistant depression after stopping an MAOI before. This is a mandatory relevant consideration, I would have thought, which the anesthetist ought to take into account and its seriousness may well prompt him to enquire further into alternative anaesthetics which do not require your stopping parnate. The authors of a retrospective cohort study (2012 J Clinical Psych 73.8) concluded that "[s]evere adverse hemodynamic events, such as hypertension and tachycardia, *did not* occur more frequently in users of both the irreversible MAOI tranylcypromine and the reversible MAO-A inhibitor moclobemide compared to non-users. These findings suggest that there is no longer much justification to discontinue these MAOIs before surgery, *with the considerable risk of compromising patients' psychiatric status.*"
http://www.ncbi.nlm.nih.gov/pubmed/22938842
Have you also thought of asking your surgeon to make enquiries about an alternative anesthetist who is otherwise as trusted and competent but has more advanced knowledge of and experience with MAOIs?
Good luck.
Posted by SLS on July 20, 2015, at 15:55:39
In reply to Re: Stopping Parnate for surgery? Help! » SLS, posted by Robert_Burton_1621 on July 20, 2015, at 14:11:11
> Stahl states (2012 CNS Spect 17.1) that fentanyl is strictly prohibited. Gillman (2005 Brit J Anaesthesia 95.4) concludes that it has "possibly" caused fatalities from serotonin toxicity.
The Stahl article is probably more recent than the literature I used to suggest the safety of fentanyl. I agree with your concerns and would not recommend using it.
I didn't realize that fentanyl is a weak inhibitor of serotonin reuptake.
- Scott
Posted by Lou Pilder on July 20, 2015, at 19:04:24
In reply to Stopping Parnate for surgery? Help!, posted by Uncouth on July 20, 2015, at 10:20:26
> So I am having major sleep apnea surgery August 20th. I have asked my surgeon to check with anesthesiologist with respect to which medications I need to stop and what I can stay on.
>
> Unfortunately he has stated that I need to stop my 120mg tranylcypromine two weeks before surgery. I am quite worried as years ago when I stopped an MAOI I fell into an ECT resistant depression (though was in much worse general shape then, and recovery from sleep apnea surgery will include hydrocodone).
>
> In any event, if I can't get the anesthesiologist to let me remain on MAOI, what would be the best tapering protocol over the next month to reduce the chance of mood disturbance.
>
> I am worried, but am also on other medications that hopefully will help "pick up the slack":
>
> Ability 2mg
> Strattera 100mg
> Namenda XR 21mg
> Parnate 120mg (need to taper off)
>
> Anyone have any experience with tapering off of high dose MAOI? I am frustrated as it took a long time to work up to this dose and I feel like it just started to kick in. What will I expect?Friends,
Be not deceived to think that it is perfectly safe to take the combination of drugs listed here. In fact, the danger of death from the drugs is well-known when a stimulant drug like Strattera is combined with Parnate which could induce such high blood pressure to cause death.
The danger here is that the policy here is that being supportive takes precedence. But there is no warning posted from the operator here as to the potential for the combination to kill the person. And you mothers, trying to decide to drug your child in collaboration with a psychiatrist/doctor, you may think that your child could take these drugs in combination because one here is taking them. But that does not constitute a valid reason to drug your child. In fact, I would question the APA as to if they allow a psychiatrist to have a client take these drugs in combination.
Lou
Posted by baseball55 on July 20, 2015, at 19:37:33
In reply to Re: Stopping Parnate for surgery? Help! » Robert_Burton_1621, posted by SLS on July 20, 2015, at 15:55:39
I had major surgery two years ago on parnate, though a much lower dose than you're taking. I informed the anesthesiologist and s/he planned accordingly. Post-surgery, I took morphine and oxycodone, which are not contra-indicated with parnate.
Posted by herpills on July 21, 2015, at 12:43:26
In reply to Lou's warning-death by high blood pressure » Uncouth, posted by Lou Pilder on July 20, 2015, at 19:04:24
> The danger here is that the policy here is that being supportive takes precedence.
> LouWhat should take precedence to being supportive?
Posted by 10derheart on July 21, 2015, at 14:49:34
In reply to Re: Lou's warning-death by high blood pressure, posted by herpills on July 21, 2015, at 12:43:26
-nhelpful? Self-centered? Obsessed with imaginary problems on PB?
apparently. ;-)
Posted by Robert_Burton_1621 on July 21, 2015, at 15:53:49
In reply to Being alarmist? Hyperbolic? Extreme? Ridiculous? U » herpills, posted by 10derheart on July 21, 2015, at 14:49:34
> -nhelpful? Self-centered? Obsessed with imaginary problems on PB?
>
> apparently. ;-)It is the confident assertion of misinformed opinion and sweeping anti-medication prejudice that is most concerning. Such misinformation is offered portentously as if it were hard-headed but ultimately necessary advice which places a priority on the best interests of the perplexed poster in preference to the facile and irresponsible provision of a form of "support" whose consequences lead directly to death. On one side, we have the lone, courageous and ethically-irreproachable truth-teller whose warnings of death and disaster fall too frequenlty on deaf ears; on the other, we have the fickle mob of enabling "supporters", whose amorality makes it easy for them without conscience to become complicit in psychiatry's conspiracy to make its patients worse rather than better off.
The most pitiful and lamentable casualties of this binary battle are nuance, well-informed research, evidence-based reasoning, a willingness rationally to consider counter-arguments, and an acknowledgement of one's own limitations.
Alarmist? Hyperbolic? Extreme?
Yes. Objectively these are accurate characterisations, however sincere a person believes his or her subjective intention is.
Posted by Lou Pilder on July 21, 2015, at 15:59:39
In reply to Being alarmist? Hyperbolic? Extreme? Ridiculous? U » herpills, posted by 10derheart on July 21, 2015, at 14:49:34
> -nhelpful? Self-centered? Obsessed with imaginary problems on PB?
>
> apparently. ;-)Friends,
Many of you already know that I am here to save lives, prevent life-ruining conditions and addictions. And I am trying so hard, laboring under many prohibitions posted to me here by Mr. Hsiung, to free the captives and lead people back to the green fields that they used to know.
And here there are many that have been killed by the drugs being allowed to be promoted here as medicines. And worse, members post that they take a combination of drugs that if they don't kill them, they could be addicted or get a life-ruining condition. All of that under the banner of support as Mr. Hsiung's rules are under that being supportive takes precedence. That could mislead readers to think that taking a combination of drugs that could kill them is being supportive here. And look at all those that have died here that you can see. But what about those that have been killed by the drugs that you can't see here? There are thousands killed each month by these drugs. Drugs that many start with motor oil that have chemical constituents that have been used to kill insects and rats and used in the commission of mass-murder even to this day. And the mothers trying to decide. Their child could be killed by taking the combination of chemicals advocated here as being supportive as the rules state and members are in doubt?
If someone else greater than me posted here you might believe. Where have you gone Dr. Quackenbush, a forum turns its doubtful hearts to you. But as long as this being allowed here as to be seen as supportive and readers are killed by the combination of those drugs, so shall I attempt to warn them, and their blood will not be upon me.
Posted by Lou Pilder on July 21, 2015, at 15:59:56
In reply to Being alarmist? Hyperbolic? Extreme? Ridiculous? U » herpills, posted by 10derheart on July 21, 2015, at 14:49:34
> -nhelpful? Self-centered? Obsessed with imaginary problems on PB?
>
> apparently. ;-)Friends,
Many of you already know that I am here to save lives, prevent life-ruining conditions and addictions. And I am trying so hard, laboring under many prohibitions posted to me here by Mr. Hsiung, to free the captives and lead people back to the green fields that they used to know.
And here there are many that have been killed by the drugs being allowed to be promoted here as medicines. And worse, members post that they take a combination of drugs that if they don't kill them, they could be addicted or get a life-ruining condition. All of that under the banner of support as Mr. Hsiung's rules are under that being supportive takes precedence. That could mislead readers to think that taking a combination of drugs that could kill them is being supportive here. And look at all those that have died here that you can see. But what about those that have been killed by the drugs that you can't see here? There are thousands killed each month by these drugs. Drugs that many start with motor oil that have chemical constituents that have been used to kill insects and rats and used in the commission of mass-murder even to this day. And the mothers trying to decide. Their child could be killed by taking the combination of chemicals advocated here as being supportive as the rules state and members are in doubt?
If someone else greater than me posted here you might believe. Where have you gone Dr. Quackenbush, a forum turns its doubtful hearts to you. But as long as this being allowed here as to be seen as supportive and readers are killed by the combination of those drugs, so shall I attempt to warn them, and their blood will not be upon me.
Posted by Robert_Burton_1621 on July 21, 2015, at 16:36:50
In reply to Stopping Parnate for surgery? Help!, posted by Uncouth on July 20, 2015, at 10:20:26
Uncouth, I would take sceptically the assertion that the combination of parnate with strattera carries a dangerous and significant risk of causing hypertensive crisis and death.
Note that the poster who gave the warning provided no detail of the causal mechanism of the claimed risk.
There is no doubt that CNS stimulatants ought be used cautiously with MAOIs. Amphetamine has been implicated in deaths (subarachnoid hemorrhage) when combined with MAOIs, probably as a result of noradrenergic toxicity. However, chlorpromazine seems to reduce the toxity.
Amphetamine is a *releaser* (indirect agonist) of noradrenaline. Tyramine is also such a releaser, and for this reason can cause a hypertensive crisis if consumed in sufficient potency. This is why people on MAOIs must follow a restricted diet.
But not every medication with a capacity to increase noradrenergic neurotransmission acts as a *releaser". In fact, the NRIs roboxetine, nortriptyline, wellbutrin, can actually prevent a tyramine-induced hypertensive response.
Consult: http://www.psychotropical.com/maois-and-cns-stimulants, and the references there cited.
Ritalin, which acts as an NRI and DRI, has been used in combination with MAOIs for decades but Gillman, a meticulously thorough researcher, could not identify any reports of death.
Strattera is also an NRI, so it would assist in reducing the pressor effect of tyramine. It is reasonable to deduce that the risk it carries of inducing a hypertensive crisis when co-adminstered with parnate is analogous to that of ritalin or wellbutrin, which is very small when their co-administration is monitored properly.
Atomoxetine (strattera) does not appear to be a potent NRI anyway, since even overdoses up to 1500mg have not, apparently,induced death via noradrenergic toxicity.
For more well-reasoned and supported information, see Gillman's excellent site and:
Feinberg SS., "Combining stimulants with monoamine oxidase inhibitors: a review of uses and one possible additional indication," Journal of Clinical Psychiatry (2004) 65: 1520-4.
Posted by Lou Pilder on July 21, 2015, at 16:48:37
In reply to Lou's response-their blood » 10derheart, posted by Lou Pilder on July 21, 2015, at 15:59:56
> > -nhelpful? Self-centered? Obsessed with imaginary problems on PB?
> >
> > apparently. ;-)
>
> Friends,
> Many of you already know that I am here to save lives, prevent life-ruining conditions and addictions. And I am trying so hard, laboring under many prohibitions posted to me here by Mr. Hsiung, to free the captives and lead people back to the green fields that they used to know.
> And here there are many that have been killed by the drugs being allowed to be promoted here as medicines. And worse, members post that they take a combination of drugs that if they don't kill them, they could be addicted or get a life-ruining condition. All of that under the banner of support as Mr. Hsiung's rules are under that being supportive takes precedence. That could mislead readers to think that taking a combination of drugs that could kill them is being supportive here. And look at all those that have died here that you can see. But what about those that have been killed by the drugs that you can't see here? There are thousands killed each month by these drugs. Drugs that many start with motor oil that have chemical constituents that have been used to kill insects and rats and used in the commission of mass-murder even to this day. And the mothers trying to decide. Their child could be killed by taking the combination of chemicals advocated here as being supportive as the rules state and members are in doubt?
> If someone else greater than me posted here you might believe. Where have you gone Dr. Quackenbush, a forum turns its doubtful hearts to you. But as long as this being allowed here as to be seen as supportive and readers are killed by the combination of those drugs, so shall I attempt to warn them, and their blood will not be upon me.Friends,
If someone greater than me told you what I also posted, would you stand up and walk out on me?
Here is a vid that is by one greater than me, Dr. Peter Gotzsche. Maybe you will listen to him.
Lou
to see this video bring up Google and type in:
[ youtube, dozpAshvtsA ]
Posted by 10derheart on July 21, 2015, at 19:21:14
In reply to Re: Being alarmist? Hyperbolic? Extreme? Ridiculous? U » 10derheart, posted by Robert_Burton_1621 on July 21, 2015, at 15:53:49
You have quite the way with words, Robert Burton. Yes, indeed.
I assume this group is supposed to include me...
>>...on the other, we have the fickle mob of enabling "supporters", whose amorality makes it easy for them without conscience to become complicit in psychiatry's conspiracy to make its patients worse rather than better off.
You don't know me, so I'm not sure what's up with the labeling. I will say I am generally not fickle, definitely not amoral or without conscience, or complicit in anything to do with psychiatry or its patients. Haven't been to a pdoc in over 11 years, nor have I studied the current state of the field at all so I could form an overall opinion of its helpfulness. It is Mr. Pilder's tone and tactics I criticize. His message, if it is anti-drug, is welcome in the interest of free speech, to the extent Dr. Bob allows that. (Which is apparently 100% at the moment.)
PB is too anemic and underpopulated to produce any sort of "mob." If only that were possible, it might be worth it to again have more robust and varied dialog. But, the past is the past, I guess.
Posted by Robert_Burton_1621 on July 21, 2015, at 19:41:53
In reply to Re: Being alarmist? Hyperbolic? Extreme? Ridiculous? U » Robert_Burton_1621, posted by 10derheart on July 21, 2015, at 19:21:14
> You have quite the way with words, Robert Burton. Yes, indeed.
>
> I assume this group is supposed to include me...
>
> >>...on the other, we have the fickle mob of enabling "supporters", whose amorality makes it easy for them without conscience to become complicit in psychiatry's conspiracy to make its patients worse rather than better off.
>
> You don't know me, so I'm not sure what's up with the labeling. I will say I am generally not fickle, definitely not amoral or without conscience, or complicit in anything to do with psychiatry or its patients. Haven't been to a pdoc in over 11 years, nor have I studied the current state of the field at all so I could form an overall opinion of its helpfulness. It is Mr. Pilder's tone and tactics I criticize. His message, if it is anti-drug, is welcome in the interest of free speech, to the extent Dr. Bob allows that. (Which is apparently 100% at the moment.)
>
> PB is too anemic and underpopulated to produce any sort of "mob." If only that were possible, it might be worth it to again have more robust and varied dialog. But, the past is the past, I guess.10derheart, I think you have misinterpreted me. The quote you cite was not a serious characterisation of anyone, but an attempt to express how it seems that many of us are assumed to be from the perspective of the gentleman in question. It was intended to satirise this perspective when it expresses itself hyperbolically and at the expense of reasoned dailogue which accepts that posters who refuse to agree with the hyperbole are therefore complicit in "supporting" choices to continue with medication which is asserted to be lethal.
Apologies if that satirical purpose wasn't entirely clear. In the past I have entirely agreed with your totally reasonable views on the gentleman's "tone and tactics", and still do.
Needless to say, nothing in the words you extract was meant to articulate my view of you or anyone else at PB.
Posted by Lou Pilder on July 21, 2015, at 20:13:26
In reply to Lou's response-someone greter than me, posted by Lou Pilder on July 21, 2015, at 16:48:37
> > > -nhelpful? Self-centered? Obsessed with imaginary problems on PB?
> > >
> > > apparently. ;-)
> >
> > Friends,
> > Many of you already know that I am here to save lives, prevent life-ruining conditions and addictions. And I am trying so hard, laboring under many prohibitions posted to me here by Mr. Hsiung, to free the captives and lead people back to the green fields that they used to know.
> > And here there are many that have been killed by the drugs being allowed to be promoted here as medicines. And worse, members post that they take a combination of drugs that if they don't kill them, they could be addicted or get a life-ruining condition. All of that under the banner of support as Mr. Hsiung's rules are under that being supportive takes precedence. That could mislead readers to think that taking a combination of drugs that could kill them is being supportive here. And look at all those that have died here that you can see. But what about those that have been killed by the drugs that you can't see here? There are thousands killed each month by these drugs. Drugs that many start with motor oil that have chemical constituents that have been used to kill insects and rats and used in the commission of mass-murder even to this day. And the mothers trying to decide. Their child could be killed by taking the combination of chemicals advocated here as being supportive as the rules state and members are in doubt?
> > If someone else greater than me posted here you might believe. Where have you gone Dr. Quackenbush, a forum turns its doubtful hearts to you. But as long as this being allowed here as to be seen as supportive and readers are killed by the combination of those drugs, so shall I attempt to warn them, and their blood will not be upon me.
>
> Friends,
> If someone greater than me told you what I also posted, would you stand up and walk out on me?
> Here is a vid that is by one greater than me, Dr. Peter Gotzsche. Maybe you will listen to him.
> Lou
> to see this video bring up Google and type in:
> [ youtube, dozpAshvtsA ]Friends,
Let us enter the conversation with the hypothetical people, Dr. Quackenbush and client Helen Weilz.
Dr. Quackenbush: How do you feel today, Helen?
Helen Weilz: I am feeling pretty sick now.
Dr. Quackenbush: Do you want me to call you an ambulance?
Helen Weilz: I have been called worse than that.
Dr. Quackenbush: Well, did you take a shower this morning?
Helen Weilz: Why, is there one missing?
Dr. Quackenbush: Have you been looking at that "Dr. Bob" site?
Helen Weilz: That Lou guy says that taking Strattera with Parnate could cause death. Is he right?
Dr. Quackenbush: Yes, he is. The two taken together is contraindicated and could raise blood pressure that could cause death. I would never prescribe them both together
Helen Weilz: But this other guy says that taking a stimulant with Parnate like Ritalin, could not cause such and Strattera is a stimulant.
Dr. Quackenbush: But just because they are both stimulants, they could have two different modes of action with Parnate. Like if there were two snakes to handle, one could inject in its bite poison and the other not, even though they are both snakes.
Helen Weilz; Hey that really clears that up. I think that you ought to enter that forum and help them think like that. Another poster writes of great fear about taking drugs. There is a whole lot of shakin' goin' on.
Dr. Quackenbush; I will look into that site and see if I can help those people.
Lou
Posted by 10derheart on July 22, 2015, at 0:58:57
In reply to Re: Being alarmist? Hyperbolic? Extreme? Ridiculous? U » 10derheart, posted by Robert_Burton_1621 on July 21, 2015, at 19:41:53
Ahh...thanks for clarifying. Now I've re-read your post I can see another meaning - the one you intended :-) Maybe I was unconsciously in some sort of defensive mode when I read it before. I won't pretend to understand my own states of mind completely....just better than I used to! ;-)
Oops. Apologies.
Words are so beautiful, yet so tricky and downright devilishly complicated to navigate sometimes. Then add in asynchronous communication and you have a poor recipe for understanding.
Posted by Lou Pilder on July 22, 2015, at 5:45:54
In reply to Re: Being alarmist? Hyperbolic? Extreme? Ridiculous? U » Robert_Burton_1621, posted by 10derheart on July 21, 2015, at 19:21:14
> You have quite the way with words, Robert Burton. Yes, indeed.
>
> I assume this group is supposed to include me...
>
> >>...on the other, we have the fickle mob of enabling "supporters", whose amorality makes it easy for them without conscience to become complicit in psychiatry's conspiracy to make its patients worse rather than better off.
>
> You don't know me, so I'm not sure what's up with the labeling. I will say I am generally not fickle, definitely not amoral or without conscience, or complicit in anything to do with psychiatry or its patients. Haven't been to a pdoc in over 11 years, nor have I studied the current state of the field at all so I could form an overall opinion of its helpfulness. It is Mr. Pilder's tone and tactics I criticize. His message, if it is anti-drug, is welcome in the interest of free speech, to the extent Dr. Bob allows that. (Which is apparently 100% at the moment.)
>
> PB is too anemic and underpopulated to produce any sort of "mob." If only that were possible, it might be worth it to again have more robust and varied dialog. But, the past is the past, I guess.10,
You wrote,[...It is Mr. Pilder's tone and tactics that I criticize...].
What you have posted about me here could induce hostile and disagreeable opinions and feelings toward me and decrease the respect, regard and confidence in which I am held. This is all because your criticisms toward me and what the tone is can not be seen. If you could post answers to the following, then I could respond accordingly.
A. What is the tone that you are criticizing me for?
B. What are the tactics that you are criticizing me for?
C. Do you want me to be prevented from posting here what I think could save lives, prevent life-ruining conditions and addictions and if so, why would you want to prevent me from doing that?
D. Do you think that by Mr. Hsiung and his deputies of record using the tactic of discrimination by denying me equal protection of his rules by not acting on my notifications here, that by him and his deputies of record doing that, this community will be improved as Mr. Hsiung states that he does what in his thinking will be good for this community as a whole?
E. Mr. Hsiung wants you to trust him in that. Are you trusting him in thinking that by him and his deputies of record allowing anti-Semitic propaganda to be seen as supportive here, that this community will be "good" for him and his deputies of record doing that?
F. If you post here what you are criticizing me for, and that decreases the respect, regard and confidence in which I am held so that some readers are killed by the drugs that are being allowed to be promoted here as medicines, would their blood be upon you?
Lou
Posted by Lou Pilder on July 23, 2015, at 9:21:31
In reply to Re: Being alarmist? Hyperbolic? Extreme? Ridiculous? U » 10derheart, posted by Robert_Burton_1621 on July 21, 2015, at 15:53:49
> > -nhelpful? Self-centered? Obsessed with imaginary problems on PB?
> >
> > apparently. ;-)
>
> It is the confident assertion of misinformed opinion and sweeping anti-medication prejudice that is most concerning. Such misinformation is offered portentously as if it were hard-headed but ultimately necessary advice which places a priority on the best interests of the perplexed poster in preference to the facile and irresponsible provision of a form of "support" whose consequences lead directly to death. On one side, we have the lone, courageous and ethically-irreproachable truth-teller whose warnings of death and disaster fall too frequenlty on deaf ears; on the other, we have the fickle mob of enabling "supporters", whose amorality makes it easy for them without conscience to become complicit in psychiatry's conspiracy to make its patients worse rather than better off.
>
> The most pitiful and lamentable casualties of this binary battle are nuance, well-informed research, evidence-based reasoning, a willingness rationally to consider counter-arguments, and an acknowledgement of one's own limitations.
>
> Alarmist? Hyperbolic? Extreme?
>
> Yes. Objectively these are accurate characterisations, however sincere a person believes his or her subjective intention is.Friends,
Be not deceived as to what is allowed to be posted about my character here as being seen as supportive. You could be indoctrinated here by that Mr. Hsiung states that being supportive takes precedence and that if something is not acted on by him or his deputies of record, then what is in question is not against his rules.
bUt be advised that I think that by Mr. Hsiung denying me equal protection of his rules leaving statements against me here to be seen as civil, that by him doing that, death could be a result of participating here as thinking that what can be seen unsanctioned is being supportive. This includes posters advocating to take combinations of drugs that can kill you. The question is if I am alone here in warning readers of the potential of you getting a life-ruining condition or addiction or death from these drugs and why is it allowed for posters to advocate what could cause your death and why a=is anti-Semitic propaganda allowed to be posted here with impunity? And there are prohibitions to me here from Mr. Hsiung that prevent me from educating you that in my perspective could save your life and since I am prohibited by Mr. Hsiung to post what I think could save your life, then who will have the blood of those that are killed here upon them by them that contribute to the promotion of these drugs?
Let us look at the flowing two videos.
Lou
[ youtube, KMoZcmm-9Ew ]
and
[ youtube, rjOxheddSEE ]
Posted by Uncouth on July 23, 2015, at 11:26:19
In reply to Stopping Parnate for surgery? Help!, posted by Uncouth on July 20, 2015, at 10:20:26
Despite the fact that this thread has taken a turn for the off-topic, I wanted to update everyone. My pdoc says stop as well, despite the evidence and helpful references on this thread I emailed him and the surgeon/anesthesologist.
I will be tapering down Parnate by 10mg/day over the next 13 days. I am a bit worried, but will likely escalate my doses of other medications I am allowed to stay on, Strattera 80->100mg, Namenda XR 21->28mg, Abilify 2mg->5mg if necessary, and possibly restarting armodafinil if necessary. Wish me luck.
Posted by Lou Pilder on July 24, 2015, at 8:05:26
In reply to Re: Stopping Parnate for surgery? Help! » Uncouth, posted by Uncouth on July 23, 2015, at 11:26:19
> Despite the fact that this thread has taken a turn for the off-topic, I wanted to update everyone. My pdoc says stop as well, despite the evidence and helpful references on this thread I emailed him and the surgeon/anesthesologist.
>
> I will be tapering down Parnate by 10mg/day over the next 13 days. I am a bit worried, but will likely escalate my doses of other medications I am allowed to stay on, Strattera 80->100mg, Namenda XR 21->28mg, Abilify 2mg->5mg if necessary, and possibly restarting armodafinil if necessary. Wish me luck.
>
> uncouth,
You wrote,[...My pdoc says stop...despite the evidence and helpful references in this thread..].
If you could post answers to the following , then I think that lives could be saved, life-ruining conditions and addictions could be avoided.
True or false:
A. My p-doc, Lou, p-doc says to stop the Parnate
B. There is evidence posted in this thread that contradicts my p-doc, Lou, to have me stop Parnate
C. You are correct, Lou, that the combination of Parnate with Strattera could cause death by high blood pressure
Fill in:
D. The evidence that I am referring to in this thread, Lou, is:
_____________________________________________
___________________________________________
Lou
Posted by Uncouth on July 24, 2015, at 10:49:16
In reply to Lou's urgent request-ehvahdenz » Uncouth, posted by Lou Pilder on July 24, 2015, at 8:05:26
Who the f*ck do you think you are?
Get off this site.If you actually read the references others have pointed to you would realize that a combination of an MAOI and an NRI is not only not dangerous, it is a potent and important combination for treatment resistant depression and, I will repeat what others have said, 'LOU', MAKES MAOIs SAFER AS IT SEVERELY ATTENUATES HYPERTENSIVE CRISES AS A RESULT OF TYRAMINE INGESTION.
Note that ever since I have started the atomoxetine and hit a stable and reasonable dose of 80mg, I have had no problems eating whatever I wantaged cheeses, meats, fermented foods, etc. with ZERO and I mean ZERO BP effects. Before the parnate, I would often feel transient and brief increases in BP from small levels of tyramine in even normal or safe-ish foods.
Your ideas are patently false, and I want you off my thread, you already hijacked it and took it off topic.
Posted by Robert_Burton_1621 on July 24, 2015, at 11:32:29
In reply to Re: Lou's urgent request-ehvahdenz » Lou Pilder, posted by Uncouth on July 24, 2015, at 10:49:16
Go forward in thread:
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