Persephone Posted December 21, 2009 Share Posted December 21, 2009 I know I have it in my signature, talked it about it on my blog, and alluded to it in a few of my posts - but I guess I'm feeling needy and nervous. I'm seeing my pdoc tomorrow to get a prescription for MAOIs (don't know which one yet). I have been on at least one med from every class of modern ADs in various combinations, with and without mood stabilizers. All of them either haven't worked very well or caused intolerable side effects. My pdoc thinks TCAs would not be a good fit for me. I'm going for the real deal, because EMSAM is so expensive and sounds kind of lame since you still have to follow the dietary restrictions above the lowest dose. The lowest dose of anything never works for me. The AD washout has really sucked but is a good reminder of how much I need to be on ADs. I've been an irritable, agitated wreck. I wasn't doing great before, but I had worked myself up to a low-level functionality. Now I've totally fallen apart again mainly because I just don't care about my disintigrating life. My family's kind of pissed at me Any words of advice? I did have have my "Last Supper" of Thai food and Singha (a type of Thai beer) tonight. Oh well - food restrictions don't bother me so much. I've lost so much of my life due to depression, getting a fraction of it back would be well worth the sacrifice. I know MAOIs are just another type of AD and they help a lot of people. But it all just seems so intense. I've been so anxious - but then again I've been dealing with Cymbalta withdrawal and the return of the symptoms which put me on ADs to begin with. I guess I just want to whine a bit. Link to comment Share on other sites More sharing options...
mudpuppy Posted December 21, 2009 Share Posted December 21, 2009 I seem to recall my girlfriend saying that you DON'T have to follow the dietary restrictions on Emsam... Link to comment Share on other sites More sharing options...
Mayteana Posted December 21, 2009 Share Posted December 21, 2009 The washout period is a nice reminder for why we stay on these crazy meds, but it is a bitch to go through. If you don't already do so - this would probably be a great time to start a mood chart or journal of your symptoms. Having an example of what your baseline is will make it that much easier later when you're trying to evaluate if the new med is helping. Umm advice wise, MAOI's are going to be a different beast then some other meds. I found the side effects to be far less annoying then being on an SSRI, but YMMV. While they are something you need to be careful with, it's really not as bad as it's made out to be. If you get some kind of relief, the things that you have to watch out for are still going to be so much easier to deal with then being depressed is. I think the biggest headache is the medication reactions. You have to re-evaluate anything you take - both rx or OTC. You can ask the doctor and/or pharmacist if you've got any questions. The diet really didn't bother me any. It makes you that much more aware of what you're eating, and being more mindful of making healthy choices with your diet is good for your body in general. It can be overwhelming at first having to learn to deal with being on an MAOI, but it's really all stuff that you can get used to. Like a lot of shit, you take it one day at a time. Keep us posted on how it goes. ~ May Link to comment Share on other sites More sharing options...
Mayteana Posted December 21, 2009 Share Posted December 21, 2009 I seem to recall my girlfriend saying that you DON'T have to follow the dietary restrictions on Emsam... Emsam comes in 6mg/24hr, 9mg/24hr or 12mg/24hr. At 6mg/24hr, following the MAOI diet isn't necessary - at 9mg/24hr or 12mg/24hr, they do tell you to follow it. Last I checked, there hadn't been enough research done to say for sure that the 9mg/24hr & 12 mg/24hr doses required the diet - but there also hasn't been enough research to say that they don't need the diet. So at the higher doses it defaults to the same rules as any other MAOI - aka, follow the diet. ~ May Link to comment Share on other sites More sharing options...
Persephone Posted December 29, 2009 Author Share Posted December 29, 2009 So my thoughts after one week: Keep in mind I asked my pdoc for the fastest titration schedule he could stomach (up to FDA max in 6 days - I'm of the mind the faster you find out a med is going to work or not work for you, the better), my side effects are probably more intense than average: -very tired, especially when my dose increased -lots of dizziness -anxiety and panic attacks - my pdoc is super-tight with the controls, and gave me permission to take 1-3 mg Ativan prn! I've sucked up worse anxiety before, but I'm so tired of feeling like crap, I'll take any help I can get. -loss of appetite! - MAOIs are supposed to cause weight gain (Nardil more so than Parnate), but I managed to lose weight over Christmas! -the food restrictions are not bad if you stick to the modern lists - I've consumed moderate amounts of red wine, chocolate, and coffee with no problems So my verdict: start-up effects worse than SSRIs, but no where near as bad as Effexor. But so far, no improvement on my depression May, if I may ask, why did you discontinue EMSAM? Link to comment Share on other sites More sharing options...
null0trooper Posted December 30, 2009 Share Posted December 30, 2009 -loss of appetite! - MAOIs are supposed to cause weight gain (Nardil more so than Parnate), but I managed to lose weight over Christmas! In clinical trials for selegiline, weight loss, anorexia, and poor appetite were reported. That might ease up once (if?) MAO-A starts being inhibited. I've consumed moderate amounts of red wine, chocolate, and coffee with no problems Again, with selegiline, chocolate and coffee are two things you might want to keep at low to moderate amounts. IIRC, caffeine tends to hit a bit harder on it. Link to comment Share on other sites More sharing options...
Persephone Posted December 30, 2009 Author Share Posted December 30, 2009 Null - I'm sorry I was unclear - I'm actually on Parnate Link to comment Share on other sites More sharing options...
Mayteana Posted December 30, 2009 Share Posted December 30, 2009 So my thoughts after one week: Keep in mind I asked my pdoc for the fastest titration schedule he could stomach (up to FDA max in 6 days - I'm of the mind the faster you find out a med is going to work or not work for you, the better), my side effects are probably more intense than average: -very tired, especially when my dose increased -lots of dizziness -anxiety and panic attacks - my pdoc is super-tight with the controls, and gave me permission to take 1-3 mg Ativan prn! I've sucked up worse anxiety before, but I'm so tired of feeling like crap, I'll take any help I can get. I got hit with the side effects hard too when changing doses. It mellowed out in a few weeks. And same here with the increased anxiety and addition of benzo's. I wish I had gotten on benzo's sooner, they take care of some of my most annoying symptoms. -loss of appetite! - MAOIs are supposed to cause weight gain (Nardil more so than Parnate), but I managed to lose weight over Christmas! Not all of them. I lost weight on selegiline. I am curious if an increase in appetite was one of the symptoms of your depression or not. -the food restrictions are not bad if you stick to the modern lists - I've consumed moderate amounts of red wine, chocolate, and coffee with no problems Be careful with that. To be honest, I didn't follow the food restrictions - but I had my pdoc's permission to experiment a little. For a while I checked my blood pressure on a regular basis after eating foods like that to see if there was any change. May, if I may ask, why did you discontinue EMSAM? I got diagnosed with ADHD. Stimulants and selegiline are dangerous to take together so I had to pick one. I picked medicating the ADHD and dropped the MAOI. At some point when I have better prescription coverage I'd really like to go back to the MAOI class of meds and see what I can do with switching around the rest of my cocktail. Emsam didn't relieve my depression but it made me a lot more functional - which is more then any other AD has been able to do. ~ May Link to comment Share on other sites More sharing options...
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