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I know it's not available at the moment but I believe it was at one point in Europe - does anyone have any experience with it? It's part RIMA and part SSRI, which shouldn't work but does

There is a certain irony here: "Ugh, tricyclics! Low selectivity for the serotonin transporter over the noradrenaline transporter, and what's with all the antagonism at histamine, alpha and 5HT2A receptors? Dirty stuff! Thankfully this is the 90's, and we have Selective Serotonin Reuptake Inhibitors!" "...eh, maybe you do need a bit of a noradrenaline boost on top. Thankfully this is 2000, and we have SNRI's!" "...and maybe it would be nice to have some histamine/5HT2-antagonism-mediated anti-anxiety action, too. It's 2010, try some Seroquel or Mirtazapine on top of your antidepressant!" "...and we do want some alpha1-adrenergic receptor antagonism to normalize the HPA axis! And some FIASMA / BDNF would be nice. R&D, get started! It's 2018!" "...or just have a tricyclic." I would not be surprised if they try to market anticholinergics as new groundbreaking anxiolytics in a few years from now...

Hello Comrades, I've been taking Sertraline (50mg daily) for 9 months now. Reason for taking Sertraline: Depression & SAD. Maybe some GAD. So Sertraline treats my baseline anxiety quite well, also got rid of digestion problems, but I am struggling with side effects: Motor restlessness, agitation. I've always been quite "hyperactive", but Sertraline has worsened it by a good amount. I cannot sit still, I feel I have to walk, to pace. I move my fingers and toes to "release" some of the energy. Also lots of fidgeting, rocking back and forth. I have the urge to crawl out of my skin. _ Indifference, amotivation, apathy, lethargy. I get less things done on Sertraline than before Sertraline. Just want to sit around and do nothing. It is really disconcerting, because things would happen like a major car malfunction or someone f*ck*ng me over and I'd be thinking "this SHOULD piss me off, but, meh.. whatever.."! I've been doing some reading & research and there is the hypothesis that SSRI-induced-stimulation of 5HT2C & 5HT2A receptors dampens the dopaminergic transmission in the prefrontal cortex thus causing these specific SSRI side effects. Antagonism / Inverse Agonism of these receptors should theoretically resolve the problem. What medications do antagonize / inverse agonize these receptors? Are there any other reliable theories on what is causing this? And what could help? _ Sleep disturbances, f*ck*d up sleep cycle, crappy sleep. Falling asleep is difficult, shallow sleep, waking up a lot in the night => daytime fatigue. (This week I've been sleeping a lot, maybe because the body wants to compensate for last months's bad sleep?) _ Heat intolerance + hot flashes. My entire life I've been loving warmth and heat. I was the guy who could sit at the top row in the sauna for 20min @ 100°C (212 °F), but right now I cannot even stand a mild summer. And I have been getting hot flashes lasting between 10-15 mins several times a day (I am a 29 year old male, so pretty sure it is not menopause related) _ I also lost quite a bit of weight, partially due to loss of appetite, but also due to increased metabolic rate. My appetite is back to normal, but I am still not gaining any weight. BMI 20 right now. _ Palpitations (BUM BUM BUM BUM. BUM . . . BUM . . . BUM) _ mild headaches and "pressure" in my neck. Nothing bad, but very annoying in the mid and long term. Now I don't know what to do. I need some meds with "less" side effects. I haven't tried any combination of medications yet. To my dismay my doc prefers the SSRI merry go around aka SSRI carousel. I found a new psychiatrist and I will have a first appointment in about a month, but I don't know what to suggest to him. Has anybody some experience with a similar situation? Which antidepressant would be suitable for me? If there is someone who had the same problem and found some solution: please write me. Thank you. Greetings from Germany!

Anyone have experiences on the reversible-MAOI Meclobemide (aka Manerix)? Apparently it’s not in the US (but in Europe, Australia & everywhere else). I cannot seem to get much info on this drug but from Wikipedia - seems like a promising choice for someone that has gone through most all the SSRIs, SNRIs, A/Ps etc. On (Wikipedia): Of 2300 people in multiple clinical trials who were treated with moclobemide in doses up to 600 mg with no dietary restrictions, none experienced a tyramine-mediated hypertensive reaction.[60] Moclobemide is tolerated to a similar degree to the SSRI antidepressants, although unlike SSRIs, moclobemide does not cause sexual dysfunction and gastrointestinal disturbance is less common[citation needed]. Moclobemide has been found to be superior to tricyclic and irreversible MAOI antidepressants in terms of side effects, as it does not cause anticholinergic, sedative or cardiovascular adverse effects[9] as well as not causing weight gain.[59] Unlike the irreversible MAOIs there is no evidence of liver toxicity with moclobemide.[61] Moclobemide has a similar efficacy profile compared to other antidepressants but is significantly superior to the tricyclic antidepressants and the classic (unselective or irreversible) MAOIs, in terms of tolerance and safety profile. Below, Per “Dr. Bob” (though I can’t vouch for this source) : http://www.dr-bob.org/tips/split/Experience-with-moclobemid.html “Moclobemide is the most frequently prescribed antidepressant in psychiatric practice in Finland. According to a Finnish double-blind multicenter trial, it was as good as or better than fluoxetine in all aspects when treating major depression (DSM-III-R criteria). Moclobemide was better in patients with atypical features.” “Further useful for the group of patients who might benefit from MAOIs but are too frightened of a possible hypertensive crisis to proceed with a trial of standard MAOIs.” “I now use this drug as a first choice in Depression (usually mild to moderate depression in my practice). It is usually remarkable in the absence of any exciting side effects (not much to talk about sometimes!)”

Just a poll to see what your take is on MAOI's or TCAs (for Depression)...which do you prefer, and WHY? Both are not the 1st line of treatment (says my pdoc) she is hesitant to suggest either, but i have not tried either class. Is one or the other more helpful and are they worth the side effects? (I've heard both have pain-in-the-butt side effects but why not try)

I'm currently on the Emsam 9 mg/24 hr patch plus Adderall XR 40 mg to potentiate it, and it doesn't seem to be doing its job at all. I am completely anhedonic, find no pleasure in doing anything I used to do, and my friends and family have even noted that I am quieter and don't talk much at all anymore. What's strange is that I also seem to randomly snap at people for no apparent reason from time to time (which I don't even see coming, and it happens very seldom, but enough to be troublesome). I must confess that I've resorted to wearing two 6 mg patches to get 12 mg for a few days at a time, and I seemed to feel a little bit better, but not very much—if that's the case, if I did step up to the 12 mg patch, I wonder just how much benefit I would actually get out of it? Should I stick with Emsam and go up to the 12 mg patch before switching to something else, or ditch the Emsam and switch to something else? If I switch to something else, I was thinking about Parnate. I don't want to take Nardil because of the associated weight gain, sedation, hepatotoxicity, and vitamin B6 deficiency. Marplan I believe also causes hepatotoxicity and vitamin B6, but I can't seem to find anything that says for sure whether it causes sedation or weight gain, so I'm on the fence about that one. I have idiopathic hypersomnia and am prediabetic, so sedation and weight gain are both nono's for me. Parnate I've heard is quite stimulating and can even cause weight loss. Even though it's conventionally contraindicated, my pdoc would likely add a stimulant to the Parnate after I get settled with the dosage to help with my IH and ADHD and to potentiate the antidepressant effects of the Parnate. Can anyone share their Emsam and/or Parnate experiences please? It would be much appreciated. Thanks!

Anyone been on Nardil or other MAOIs? I'm not real excited about the diet and potential side effects but I'm willing to try anything at this point. I've tried tons of ADs, AAPs, mood stabilizers, just about everything except tricyclics, plus a failed round of TMS. Really hoping Nardil is the answer. any experiences or tips are appreciated!

Hey all, had a rather upsetting appointment with my psychiatrist and wanted some advice please. Saw my psychiatrist who showed me a letter he wrote to my gp saying basically given my knowledge of antidepressants and having an opinion of what antidepressants I want to be prescribed that he suspects I might be doctor shopping, not being honest about what medications I am taking and wants to call the doctor shopping hotline to check my prescription history and wants a blood test to test for recreational drugs. I'm still getting over the shock but key points; Have not taken any recreational drug other than marijuana, last taken 17 years ago when I was 19! Rarely drink Have given him an accurate account of medications I have tried, all prescribed by my gp I do have a strong opinion on what I want to be prescribed as having had major depression for 17 years I know what has worked and what hasn't, plus I have done my own research, for instance on MAOI's which has led me to discover Ken Gillman from psychotropical.com.au. I am a strong advocate for patients being empowered and acting as their advocate and questioning/having input on their treatment. I am being responsible and am seeing a psychologist regularly for counselling and exercising. So my question is do I give my permission for him to access my prescription history or seek a new psychiatrist as the trust is clearly not there which makes it impossible to have an honest, open collaborative approach to my mental health. And one final question if anyone is still reading (sorry long rambling post). I am on Parnate currently and think I will need to augment this. I am interested in trying nortriptyline and or aripiprazole. Does anyone have experience with these who can share their experiences or anyone with a good knowledge of pharmacology care to offer some advice/opinions?

Hi. I am about to start MAOi treatment next week. Could you please advice me on: Texturized Vegetal Protein (soy meat) Not fermented. MSB (glutamate in all form and shapes, including maltodextrin, hydrolized protein, etc) Sweeteners (Aspartame and company) I have several low tyramine diet guides, but they often contradict each other in a point or another, like peanuts, chocolates and avocados. I wish there was a FAO guideline already! thanks for your help, guys!

Hi everybody! A while ago I asked about switching to MAOIs from tricyclics. I ended up switching from imipramine to clomipramine instead with (surprise!) no results. Now I'm actually making the switch from clomipramine to Nardil/phenelzine. I just wanted to know of anybody who has been on Nardil, what side effects they had and how they found it, especially those suffering from severe or treatment resistant depression. I have a history of serotonin syndrome which worries me a bit but I'm going up slow (15mg a week) with a seven day washout. Hopefully, since my SS is usually caused by combinations of tricyclics with Pristiq, I will be okay but I'd like to know if anybody else has had problems and what helped/didn't. I am scared but I always hate switching meds and I'm pretty miserable at the moment as well. If anybody wants to talk to me that'd be great. I'm exhausting myself worrying and just want concrete information, be it good or bad, to arm myself against the fancy conjured by my imagination. Thanks gang.

Hello all! I have 'severe' treatment resistant depression? I'm currently on 225mg of imipramine with 30mg of T3 (thyroid) for augmentation. After six weeks of waiting I had two weeks of bliss where i was 'cured' but then it just failed to settle. Unfortunately I've been having huge problems with anxiety and panic attacks. The only way I've been able to outrun these episodes is to increase the imipramine to this high level but I can't go any higher than 250mg. Has anyone else had problems with imipramine/t3 and anxiety? I see my pdoc Tuesday and he wants me to shift to a MAOI. But to do that I have to come off both drugs and stay antidepressant free for a week, maybe two, until they're out of my system before I can go on the new stuff. I can't afford to go to hospital so I have to do this at home but I'm very frightened of the anxiety/panic attacks getting worse if I withdraw. They're very severe and I don't know if they're med caused or bcos my illness has gotten worse. It will take months to come off imipramine and I can't live with anxiety for that long. Has anyone here ever withdrawn from imipramine? I've been on it for 3-4 months now so I'm going to get hit. Is there any medication I can take with imipramine to help with anxiety? I have a history of bad serotonin syndrome so I can't take SSRIs or SNRIs or other tricyclics. Also should I try anything else before MAOIs? Californian rocket fuel? Wellbutrin? I don't know what the next step is. It's been over a year since I had to quit work and study for a life at home trialling meds day after day so I'm getting a bit desperate.

i'm looking for ideas for a sleep med that doesn't interact badly with parnate. i can't take seroquel anymore (screaming in my sleep), and melatonin or benzos don't work. i've tried some other AAPs before with bad prolactin effects so those are out, except abilify, which is activating for me (but maybe there are some i haven't tried and didn't think of). pdoc was kinda stumped about what else to try (she isn't my regular pdoc, mine is away for several months). so i thought i'd do a little research myself to see what kind of options i have. she turned up her nose at trazadone, i'm not sure if that's a bad interaction or what. thanks if anyone has ideas!

Hi, Recently I have read about a combination of Nardil and Bioperine (regarding the problem with the current version of Nardil and its absorption into the bloodstream): "Nardil was changed in late 2003, due to a complete reformulation by Pfizer, who removed many of the excipient ingredients, including the hard coating. It is possible that the current version is not surviving the stomach acid content and therefore not as much is being absorbed into the bloodstream." I wonder, if anyone here has tried this combination yet ? and if so, Have you seen any improvement in regards to Nardil ? I have also read (in a link I posted above), that it is best to take Nardil on an empty stomach and take it with alot of water (no food and no juice) just water! and then give a Nardil a good 45mins in your stomach with only water...then you should probably see a positive difference in effect. I also wonder, if anyone here has tried this trick ? Thanks, Mike

Hi, I have bulumia which I can reasonably control, some general anxiety - also not too bad but I've had trichotillomania for several years & now it's really bad. I've tried two SSRIs Zoloft & Lexapro 50mg & 10mg but the nausea side effects of both were so bad that I couldn't keep taking them as they were causing a serious bulumia relapse. I am seeing the doctor soon & the two main side effects I cannot deal with are nausea & weight gain. Is it worth trying any of the a-typical anti-psychotics as the seem to all cause weight gain? I've tried Seroquel 25mg and it just made me insanely hungry but not sure if the dosage needed to be higher. Am considering an MAOI like Mannerix but people seem to say meds for tics and tourettes work well also - any advice at all would be so helpful. Finally I live in Ireland so some drugs you guys have aren't available here & my doctor needs me to educate her - most doctors here really don't know much about trich.

I'm looking for some advice. I've had a lot of experience with different antidepressants, and almost no success. I'm getting pretty tired of the whole trial-and-error process, and I'm not terribly confident in my doc's ability to prescribe the right thing, especially considering some special circumstances. Here's my history. I have been diagnosed with social anxiety and dysthymia. I've had both as long as I can remember. My first experience with taking antidepressants was Paxil when I was 16. This actually seemed to work well, cleared the anxiety and depression right up. I eventually tapered off the Paxil without any major withdrawal symptoms, but due to a significant life change my anxiety and depression came back. I tried using Paxil again, but I did not get any better (due to tachyphylaxis, I suppose). After that, I tried Celexa which made me feel irritable, like my muscles wouldn't stop tensing up, and like there was a gorilla sitting on my chest. After that I took Effexor, which all I can remember was the horrible withdrawal symptoms I had when I discontinued it. I was then put on Cymbalta, on which I felt very similar side effects to Celexa. Cymbalta had a hell of an awful withdrawal phase. I was also prescribed Buspirone and Wellbutrin with the Cymbalta, but neither had any effect. I later took Desipramine, which I do not remember feeling any better or worse under, and then a year later tried Lamictal, under which I again felt unbearable muscle tension, like a gorilla was on my chest, irritation etc. There's one more added wrinkle. I have reason to believe that I'm still experiencing post-SSRI sexual dysfunction, as I am unable to feel any sensation in my genitals. This has been the case off and on since I started taking Paxil in my teens. I've been trying to find a cure for this ever since. As you might suspect, I have a lot of reason to feel skeptical about taking any medication, but I worry that unless I try something I'll never get my anxiety and depression licked. My doctor has suggested Viibryd, but since it is an SSRI I am worried it will contribute to my sexual problems (I have heard it is without sexual side effects, but I've heard that before). It seems to me that the remaining option is to take an MAOI, but I am hesitant because a) I don't want to waste a lot of money on another something that might not work, and b) I am still worried that another antidepressant will make my sexual dysfunction worse. So, since my doc is willing to discuss options with me, I'm wondering if anyone here has any suggestions, i.e. if any of the stuff I've described throws up any red flags for something that might work, or if I should try the Viibryd, ask for an MAOI, or even push for ECT. I'm really considering any option at this moment. Even starting exercise.