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Alpam

Want to try a MAO-I

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Hi all,

I am wanting to ask to be put on a MAO-I when I see my doctor next, but I want to go in with a recommendation, either Parnate or Nardil (only two available in Australia)

In the past I have tried SSRI's (Horrible side effects no improvement) and Mirtazapine (gained 20kg in 2 months and was a complete zombie).

Currently I am on 20mg valium during the day, 25mg Seroquel for sleep and 275mg of the Tricyclic Dothiepin.

When I started the Dothiepin I had no bad side effects and it seemed that it was the first anti depressent to actually do something. since then the good effects have worn off and my doc just wants to keep upping the dose, sometimes it works for a day or two then I am back to my usual self. Last appointment I asked if going to a MAO-I would be helpful and he just shruged.

What I want in a medication is to be less depressed obviously, get rid of my horrible anxiety (nothing sets off my anxiety it just comes and goes as it pleases), allow me to feel awake during the day (always tired even though I sleep 12 hours a night) alow me to get to sleep (Dothiepin and Seroquel are gettng me to sleep at the moment), allow me to concentrate, increase my motivation, increase energy during the day and to just feel good about myself.

I don't know if this question has been answered before (been looking but I have horrible concentration).

From what I have read Parnate is stimulating and great for depression, but not the best for sleep or anxiety. Nardil is great for anxiety and depression but is sedating and wont give me the energy or concentration I want.

So if anyone has any experiences or recommendations please help me out!

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all the things you list that you want a med to do- well in an ideal world there would be one med that would do all of those things( cure the symptoms).

most of us find that even if a med is mostly helpful, we have to put up with side effects

( some things we are trying to get rid of can be side effect- like feeling tired). it can take years of trial and error of meds, dose levels, combinations plus therapy.

there are many meds used to treat all kinds of psych symptoms- i'm wondering why you want to request an maoi. i'd think you might want to try as many other things because the dietary restrictions can be difficult. and you really have to stick to them. did you know someone who took it or did you just research it? ( i'm assuming you know about the dietary restrictions). i'm just wondering why an maoi?

everyone reacts differently, so if someone else did well on one, it doesn't mean the other might not be good too. as always, when it comes to meds only you and your pdoc can decide what's best for you.

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I'm with mrsloony. I'd exhaust a lot of options before I would consider an MAOI. Not only are there the dietary restrictions, but you are going to have to be completely off any other anti-depressants you take currentl for a two-week wash period before you can even start the MAOI (because of potentially dangerous interactions). There is a reason that they are pretty far down the list of treatment options, near ECT.

You said you tried SSRIs... Which ones? For how long? I can take Zoloft, Paxil and Effexor (which is actually an SNRI) but the others in the same class make me feel more depressed and anxious. Has your pdoc tried augmenting any of the ADs you tried with another med like buspar, lithium or lamictil?

I understand that you want to get better. Believe me, I understand. However, there are likely still a lot of options to try before going on an MAOI.

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In the past I have tried SSRI's (Horrible side effects no improvement) and Mirtazapine (gained 20kg in 2 months and was a complete zombie).

When it comes to psych meds, "horrible side effects" is a relative term. Without knowing what happened there's no telling why it happened or how to avoid similar mishaps in the future.

Currently I am on 20mg valium during the day, 25mg Seroquel for sleep and 275mg of the Tricyclic Dothiepin.

This is a rather sedating mix of medications. What is your diagnosis? In any case, you will have to discontinue both the Seroquel and Dothiepin for up to 10-14 days before starting an MAOI. Afterwards, there is a fairly long list of medications that you will have to avoid in addition to the food restrictions.

get rid of my horrible anxiety (nothing sets off my anxiety it just comes and goes as it pleases)

Are you anxious, jumpy, irritable, and insomnic for days at a time, or just for a period of minutes/hours?

allow me to feel awake during the day (always tired even though I sleep 12 hours a night) allow me to get to sleep (Dothiepin and Seroquel are gettng me to sleep at the moment), allow me to concentrate, increase my motivation, increase energy during the day and to just feel good about myself.

Assuming normal thyroid hormone production and stable blood sugar, the meds that best improve wakefulness, concentration, motivation, and the perception of "energy" are the "activating" antidepressants and stimulants. Generally speaking, they're also among the LEAST helpful for general anxiety, panic attacks, and insomnia. You don't mention how you've reacted to Effexor, Wellbutrin, Cymbalta, Strattera, Norpramin, et al., but if you're serious about those goals, those are the meds you should be trying.

For relieving anxiety and stress levels, increased sleep, etc. it's the SSRIs, benzos, "sedating" tricyclics, and APs. Few if any of these improve concentration, motivation, or wakefulness.

Basically, no matter how much you want it, you don't get complete improvement in opposite categories at once.

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i'm wondering why you want to request an maoi. i'd think you might want to try as many other things because the dietary restrictions can be difficult. and you really have to stick to them. did you know someone who took it or did you just research it? ( i'm assuming you know about the dietary restrictions). i'm just wondering why an maoi?

I have read about the dietry restrictions and they don't really bother me, it's a sacrifice I am willing to take. I don't know anyone who has taken it before, I have just been doing research, none of my previous medications have worked and I have read that a MAO-I can help with treatment resistant depression.

When it comes to psych meds, "horrible side effects" is a relative term. Without knowing what happened there's no telling why it happened or how to avoid similar mishaps in the future.

With my last SSRI Zoloft, I felt nausious, light headed, dizzy, couldn't concentrate, that lasted about a month, after the side effects wore off, I felt no better for taking the medication. whenever I have gone off a SSRI I have gone from full dose to nothing in about a week, never had any withdrawl and I felt the same off as I did on.

This is a rather sedating mix of medications. What is your diagnosis? In any case, you will have to discontinue both the Seroquel and Dothiepin for up to 10-14 days before starting an MAOI. Afterwards, there is a fairly long list of medications that you will have to avoid in addition to the food restrictions.

My doctor does not want to put a label on me, when ringing up to get authorisation for a script, he has used the term major depression, but apart from that he wont tell me what he thinks. I would self diagnose myself as having major depression, general anxiety/panic disorder, insomnia, hypersomnia, depersonalisation disorder and possibly ADD. From what I have read Seroquel can be used in conjunction with a MAO-I, and with the Dothiepin I am already feeling the worst I have ever felt in my life, I don't think I can go any lower.

Are you anxious, jumpy, irritable, and insomnic for days at a time, or just for a period of minutes/hours?

I am anxious pretty much 99.9% of the time, nothing in particular sets it off. With my panic attacks I could be standing facilitating a workshop and be feeling fine (apart from the anxiety), then later go and make myself a cup of coffee and break down completely. Luckily my insomnia isn't as bad as others, before the Seroquel I wouldn't get to sleep till at least two hours after going to bed, sometimes up to five, I have always loved my sleep since I was a baby, and if I don't get at least 10 hours a night I am mentally and physically screwed the next day. I have had a sleep study done which didn't find anything.

Also should note that the first med I tried was Dexamphetamine, I got horribly addicted as when the effects wore off I was getting the worst anxety of my life.

I guess I know that I will never be 100% 'cured' but I am just so tired living life feeling the way that I do, I don't want to live but I don't want to die, and lately I am just getting more and more tired of living. I guess why I want to try a MAO-I is that I have heard it is the most effective for helping depression, and with nothing working so far I don't know how long I can go on trying things that may or may not work, there may be a lot of restrictions with a MAO-I but they are all better then death.

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With my last SSRI Zoloft, I felt nausious, light headed, dizzy, couldn't concentrate, that lasted about a month, after the side effects wore off, I felt no better for taking the medication. whenever I have gone off a SSRI I have gone from full dose to nothing in about a week, never had any withdrawl and I felt the same off as I did on.

Nausea's fairly common on starting an SSRI. Luckily withdrawal really isn't that common, and you seem to have missed some of the nastier side effects.

Luckily my insomnia isn't as bad as others, before the Seroquel I wouldn't get to sleep till at least two hours after going to bed, sometimes up to five, I have always loved my sleep since I was a baby, and if I don't get at least 10 hours a night I am mentally and physically screwed the next day. I have had a sleep study done which didn't find anything.

Also should note that the first med I tried was Dexamphetamine, I got horribly addicted as when the effects wore off I was getting the worst anxety of my life.

There are some things a sleep study might not do well at identifying. How well did you sleep when you were on the stimulant?

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There are some things a sleep study might not do well at identifying. How well did you sleep when you were on the stimulant?

Normally I don't sleep very well, keep waking up, tossing and turning all night, when I was on the Dex it was pretty much the same just more intense. But even though my sleep was worse, it didn't really matter because I could just take a stimulant to get me going again.

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There are some things a sleep study might not do well at identifying. How well did you sleep when you were on the stimulant?

Normally I don't sleep very well, keep waking up, tossing and turning all night, when I was on the Dex it was pretty much the same just more intense. But even though my sleep was worse, it didn't really matter because I could just take a stimulant to get me going again.

I was going to suggest going with a NARI anyway if the dex had improved your sleep. And that doesn't sound like RLS either. I'm still not sure a multiple reuptake inhibitor like Cymbalta or Elavil wouldn't be worth trying.

Still, if your anxiety was a bit more under control until the stimulant wore off, and if you really are set on an MAOI I'd suggest Emsam (selegiline) although Manerix is something I would be willing to try again.

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To be honest I have not really tried that many meds, couple of SSRI's, Mirtazapine, and Dothiepin. I didn't get any improvement with the SSRI's so my doc said that switching to another wouldn't likely help. Other meds I have had in the past include Dexamphetamine, Temazepam then the Seroquel and Diazepam which I am on now.

I'm trying out Manerix (Aurorix in Australia, generic - moclobemide). It's a newer type of MAOI (specifically RIMA) that does not have any dietary restrictions.

I have read a bit about Moclobemide, but the reports I have read have said that it is not as effective as most other anti-depressants. how has it been working out for you?

Also from what I have read I am not too worried about the restrictions or side effects from MAO-I's I have good self control and I just want to try something that works.

if you really are set on an MAOI I'd suggest Emsam (selegiline) although Manerix is something I would be willing to try again.

Unfortunatly those are not available in Australia, the only two MAOI's here are Parnate or Nardil.

Ever since I was a little kid I remember being depressed, had sleeping problems, I was anxious, and found it very hard to concentrate, although back then I didn't know why. I have tried all the alternatives to medication, exercise, good diet, seen chiropractors, nutritionists, naturopaths, psychologists, nothing has worked, the psychologist that I saw just called me weird and basically said I couldn't be helped.

I think I am leaning towards the MAOI side because I am desperate, I have been taking medication for about two years now with no improvement (apart from the Valium and Seroquel which help a bit) I don't think I can last trying a medication for a couple of months only to find it doesn't work, I have never felt happiness, never not been anxious, people say that I look like a really happy person, that's my way of dealing with my problems I think, just putting on a brave face and acting the way people expect me to. only problem is that I have been doing that for 21 years now and I don't think I can continue much longer. I am just so desperate for a break from myself I want to go the strongest thing there is in the hope it will work.

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Is it possible to mix Dexamphetamine with Nardil? I am starting to think of asking for Nardil and Dexamphetamine. This way I can have the anti anxiety effects of the Nardil and the Valium plus the stimulation of the Dex.

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Is it possible to mix Dexamphetamine with Nardil? I am starting to think of asking for Nardil and Dexamphetamine. This way I can have the anti anxiety effects of the Nardil and the Valium plus the stimulation of the Dex.

On the Parnate patient info sheet here it's "DO NOT TAKE THIS MEDICINE if you are also taking ... sympathomimetics (e.g., methylphenidate, ephedrine) ..." Nardil acts through the same mechanism as Parnate, so that combination will be just as dangerous.

Nardil, like Nardil, is an irreversible MAOI. That's how it works, by crippling both variants of the enzyme that disables serotonin, noradrenaline, dopamine, and phenethylamine. It is inherently unsafe with any medication that stimulates production or release of those chemicals or acts as a reuptake inhibitor.

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Even if you are able to try one of these, i worry about you getting your hopes up so high that THIS is the pill that is going to work.

remember- it is another pill choice for pdocs- its not necessarily "stronger " or "better".

it has side effects too ( and potentially dangerous ones if mixed with the wrong med or food)

you might want to read member signatures as you read around- many list current and past meds. it might give you an idea of what (and how many) meds are out there.

also remember- a current helpful med for one, might be a past disaster med for someone else.

There is no one answer- and something we all agree on is that it sucks!

null could tell you better- but there are many choices for anxiety in addition to valium other anti-anxiety meds are more commonly used here (us) these days than valium.

and there are whole other classes of medications that can help with anxiety and depression- not necessarily just anxiolitic and antidepressants.

I find it unusual that your pdoc you say won't tell you your diagnosis. it might be helpful to talk to pdoc about this. and to discuss in detail, what you hope to get from meds and about the side effects you experience. it usually works out better if you feel you can work together.

you may want to to a search or ask people's experiences with maois and others.

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An MAOI is a big step. Just be sure.

Look at my signature and you'll see the long list of things that did not work. Only remeron worked for a while - 2.5 years, and the rest have been near hit and miss since 1998. 10 years of trials.

MAOI is a commitment. Diet restrictions, lots of drug interactions, I wear medic-alert dog tags now in case I'm in an accident, and I have a card in my wallet on top of my license. This is in addition to telling SELECT few people (my typical emergency contacts for work, etc.) about my MAOI status without elaborating on why. I'm sure they've googled MAOI - Wikipedia states this in plain english:

"Monoamine oxidase inhibitors (MAOIs) are a class of powerful antidepressant drugs prescribed for the treatment of depression. They are particularly effective in treating atypical depression, and have also shown efficacy in smoking cessation...."

Be prepared that those you have trusted with this private info CAN PROBABLY GUESS why you're using one.

My experience with MAOI is limited to the Emsam patch, which I'm finding easy to use and discrete.

I also carry with me in my PDA the list of foods / meds to avoid, and have informed ALL relevant med care providers of my status - meaning they scribble MAOI USER in big letters conspicuously on my charts.

Like I said, if you're gonna do this right, safely, it is INVOLVED.

The diet changes are not too bad, although I have not had sushi since I began. That's a pisser.

For my own part I use Emsam with Lithium and I am increasingly hopeful this is the right direction.

Do your research and good luck

tg

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Thanks for your help guys, you have all given me a lot to think about. I guess I have been putting this class of medication on a pedestal thinking it is the holy grail of anti-depressants.

If I do go down this path I realise there is a lot I need to do ensure I don't take anything I am not supposed to, which might be hard for me seeing as I have told nobody I know about my problem.

I have no idea what I am going to ask for when I have my next appointment in a weeks time, all I know is that my current meds are not helping me. I have listed out for my pdoc what I want to get out of my meds (bloody long list), and he has even said that he has no idea what will and will not work for me. I am still tempted to ask for a MAOI next time I go but in the end he does have a lot more knowledge than me in medications, so I will have to leave it to him to try and decide the next course of action.

On a side note, on the product information for Nardil it says MAOI's should not be used with stimulants, but doing a bit of research there are many stories where a combination of the two has worked wonders.

Thanks for your input guys, please keep the suggestions and information coming.

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On a side note, on the product information for Nardil it says MAOI's should not be used with stimulants, but doing a bit of research there are many stories where a combination of the two has worked wonders.

How many of these "worked wonders" stories have you found, out of the millions of people being treated for depression (or with ADs anyway)? And how many are left after removing the group that involved depression with comorbid ADHD? Did your research turn up the dosages used?

That's how bad the odds of it being an appropriate treatment really are.

The thing with the reuptake inhibitors and the MAOIs is that they generally do not stimulate neurotransmitter release. No release, no chemicals to keep in circulation, no chemicals to stop disabling. Stimulant meds are very good at noradrenaline, dopamine, and even serotonin release. Combining either type inhibitor with a stimulant gets the transmitters released and keeps them in circulation. Using an MAOI, you can even keep dopamine transmission up.

But using an MAOI also means that a significant portion of the chemicals force-released STAY in circulation and can build up. That's a slow route to serotonin syndrome, and if you get put in a real "fight-or-flight" situation the noradrenaline release can hit like a jackhammer (not good for blood pressure or heartrate). And of course, if serotonin/noradrenaline levels get too high for too long, you'll discover new levels of insomnia.

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Guest Guest_MaiaM_*

Hi Alpam,

I've been following this debate and I just wanted to say I've been in your position and I understand wanting to try MAOIs - if I had access to good health care, I'm pretty sure I'd do it. (I have no insurance, and I live in a rough patch of the Middle East). But I've read that hypertensive crises can occur even without triggers like eating foods on the 'avoid' list and I've decided I would try an MAOI only if I move back to Europe or North America and have great access to hospitals and ambulances. That said, I've read great things about MAOIs, like this article - a physician's account - from the New York Times:

http://www.nytimes.com/2007/07/31/health/3...sion&st=nyt

If the link doesn't work, try typing "MAOI depression" into NYT's search box.

I've taken the reversible MAOI (RiMA) moclobemide and didn't find it very helpful. I wasn't as depressed but my anxiety was as crippling as ever. Now I take Lexapro and Ritalin (for my ADD) - and an occasional clonazepam - and I'm doing all right.

I wish you luck - and please keep us posted,

Maia

On a side note, on the product information for Nardil it says MAOI's should not be used with stimulants, but doing a bit of research there are many stories where a combination of the two has worked wonders.

How many of these "worked wonders" stories have you found, out of the millions of people being treated for depression (or with ADs anyway)? And how many are left after removing the group that involved depression with comorbid ADHD? Did your research turn up the dosages used?

That's how bad the odds of it being an appropriate treatment really are.

The thing with the reuptake inhibitors and the MAOIs is that they generally do not stimulate neurotransmitter release. No release, no chemicals to keep in circulation, no chemicals to stop disabling. Stimulant meds are very good at noradrenaline, dopamine, and even serotonin release. Combining either type inhibitor with a stimulant gets the transmitters released and keeps them in circulation. Using an MAOI, you can even keep dopamine transmission up.

But using an MAOI also means that a significant portion of the chemicals force-released STAY in circulation and can build up. That's a slow route to serotonin syndrome, and if you get put in a real "fight-or-flight" situation the noradrenaline release can hit like a jackhammer (not good for blood pressure or heartrate). And of course, if serotonin/noradrenaline levels get too high for too long, you'll discover new levels of insomnia.

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How many of these "worked wonders" stories have you found, out of the millions of people being treated for depression (or with ADs anyway)? And how many are left after removing the group that involved depression with comorbid ADHD? Did your research turn up the dosages used?

That's how bad the odds of it being an appropriate treatment really are.

This type of response is one of the reasons I am glad I turned from a long time lurker to a poster, I was afraid of getting a gentle lovey feely response to my questions when all I want and need are the cold hard honest facts.

I've read great things about MAOIs, like this article - a physician's account - from the New York Times:

[link=http://www.nytimes.com/2007/07/31/health/31case.html?scp=1&sq=MAOI+depression&st=nyt" target="_blank]http://www.nytimes.com/2007/07/31/health/3...sion&st=nyt[/link]

If the link doesn't work, try typing "MAOI depression" into NYT's search box.

I've taken the reversible MAOI (RiMA) moclobemide and didn't find it very helpful. I wasn't as depressed but my anxiety was as crippling as ever. Now I take Lexapro and Ritalin (for my ADD) - and an occasional clonazepam - and I'm doing all right.

I wish you luck - and please keep us posted,

Maia

Thanks Maia, the more I read the more I want to try a MAOI, except now I am not thinking of it as the the one that 'will cure' me, just hoping that it will be a good stepping stone for me.

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I would not trade my Parnate for anything in the world. I've been on it for amost 15 years and never had a problem. The med restrictions are not that bad and neither are the food ones. I've found the very old lists are not even close to accurate and I really only have to avoid a few categories of foods. You can have elective surgery, so don't let anyone tell you otherwise. They can operate if you are in an accident, so they can operate if it's elective. I never understood that. You must tell the doctor about your medication though because they have to make some alterations and watch you closely.

I was labeled a treatment resistant atypical depressive for 20 years and recenlty found out I have Narcolepsy. My med is the same because Parnate is THE most stimulating MAO out there. I have terrible anxiety but Parnate does not trigger it. It's possible if you get on a good dose of Parnate, you won't need a stimulant. I have to honestly say I can't remember all I've read; however, there are docs using Provigil and Parnate with no issues. I've has some success with the two as well.

I have an aneursym on my ascending aorta, so the risk of hypertensive crisis is truly life and death for me, but I have never had a problem on Parnate. It's my opinion that docs overplay the dangers of this drug. Don't misunderstand me please; there ARE dangers, but in all the years of use, I have simply found they seem to be exxagerated.

I am not the end all be all for Parnate information by any means, but I'd be happy to answer any questions about it and what I can eat, etc. since it's been the only thing to work for me and I have so many years experience taking it.

Edit to add: You can take something like klonopin at night to help you sleep if you use Parnate because it can cause you to stay awake if taken too late in the day. That would also help with anxiety. And your ADD symptoms may lessen if your concentration goes up to do not being so tired. It worked that way with my mother.

Edited by crazycatnapper

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I went and saw my doctor and told him enough was enough with the Dothiepin, dosage increases were doing nothing. I asked him if I could go on a MAOI and he said that it was pretty much a last resort because of the restrictions. He then said that he just got his hot little hands on a brand new medication that he wanted me to try, Cymbalta!

Cymbalta just became available for the first time in Australia this month, I don't know how medication becomes promoted here but he seemed quite excited with it. All the instructions he gave me was to stop the Dothiepin over a week, then take 60mg of Cymbalta after dinner.

I have never taken a SNRI before, so I am willing to give it a shot, the only other SNRI on the market here is Effexor. Then apart from that all the other anti-depressants are either SSRI's, MAOI's, Tricyclics then Moclobemide, Mirtazapine and Reboxetine. bit disappointed not to of been prescribed a MAOI, but I guess it's worth trying all the alternatives first. Alot of medications are heavily restricted over here, klonopin can only be prescribed for "Neurologically proven epilepsy" and Provigil only for proven Narcolepsy.

He also said that he wanted to start taking me off Valium, which I am a bit hesitant about, after being on it for almost a year it feels like my safety blanket. I don't know if it's still doing any good though, I still have bad anxiety almost 24/7. when the Dothiepin was helping me, I weened myself off Valium for a couple of weeks with only slightly increased anxiety, but when I tried to ween myself off again when the Dothiepin wasn't working, I got myself down to 5mg a day for about two weeks then had to go back up because I was getting panic attacks every day.

Apart from that my sleep has been horrible, I was taking 275mg of Dothiepin at night combined with 25mg of Seroquel and getting 12 hours straight sleep every night. Now that I have cut back on the Dothiepin I have had to increase the Seroquel to 50mg to get to sleep, and am now constantly waking up through the night and waking up really early in the morning unable to get back to sleep.

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