![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 89 to 113 of 488. Go back in thread:
Posted by Elizabeth on February 9, 2002, at 0:13:32
In reply to Re: depression, etc. » Elizabeth, posted by sid on February 7, 2002, at 20:38:22
> Saw my doc today. She gave me something to help me sleep (fall asleep, has 4 hours of effect only)
Ambien? Halcion? (Don't make me play this guessing game. :-} )
> and I'm staying at 75mg for at least 3 more weeks. She confirmed what I felt: I'm doing better already. We'll see, but I may not even go higher than 75mg of Effexor XR.
That would be cool. G'luck.
> I'm rather visual and remember faces more than names, so on a board like this I have trouble keeping track of who's who and who said what.
It could be worse: I'm not good with faces *or* names!
> Wel,, she was recommended to me by 2 people she treated for depression, and I notice in her waiting room, there's a lot of info on mental diseases. She may not be exceptional, but it seems like people go to her a lot for depression.
A lot of people go to their GPs for depression. HMOs don't like specialists. I don't think most GPs have much experience treating very severe mental disorders like agitated, psychotic, or melancholic depression, bipolar I, schizophrenia, etc. (Bipolar II is apparently such an all-encompassing category that I'm sure that GPs are now diagnosing and treating it.)
> I never took any drug before except aspirin, birth control pills or antibiotics.
Do you think that had anything to do with your initial reaction to Effexor?
BTW, birth control pills gave me a really bad time (depression relapsed while on Parnate). So I don't think those are necessarily lightweight drugs!
> The first week at 37.5mg per day, I slept about 2 hours per night. The first 5 days I felt "drugged." I was spacey and had trouble with my vision and psychomotricity.
"Psychomotricity?" Is that a word? :-)
> Then most side effects subsided except recurring constipation and sleep problems. After 6 weeks, I went up to 75mg and I've had sleep problems since. Once I fall asleep I sleep well, don't wake up before about 7-8 hours after, but falling sleep is a challenge. I fell asleep at 4AM this morning and had a doctor's apptment at 8:15AM.
Yeah, I've been noticing a little bit of trouble falling asleep (not normally a problem for me), and I expect it to get worse if I go up to 300 mg. I think I'll ask my pdoc for some Ambien when I see him.
> Anyway, we're trying to address that. I waste too much time because of the sleep deprivation and my work is suffering from it. I still have recurrent constipation; I simply adjust my diet accordingly.
Constipation is pretty difficult to manage. I've been taking a lot of Metamucil in the last year, and I have to say, Metamucil + anything is not my favorite beverage. < g >
> Well, I ate carbs without even noticing I was eating, I was like an eating zombie. I wouldn't say I wanted to eat, I just did it automatically. There was no pleasure in it, it was almost like an addiction: carbs, carbs, carbs. And I slept way too much during the depression. A big couch potato. :-(
The sleeping thing I can understand. My sleep was terrible, and it would have been cool to have some escape.
> Good for you. It sounds like you're on the right path to OKness or at least for now for betterness!
Yeah, one day we'll all reach OK. (I wonder if the Oklahomans are ready for us? :-} )
-elizabeth
Posted by sid on February 9, 2002, at 9:03:21
In reply to Re: depression, etc. » sid, posted by Elizabeth on February 9, 2002, at 0:13:32
> > Saw my doc today. She gave me something to help me sleep (fall asleep, has 4 hours of effect only)
>
> Ambien? Halcion? (Don't make me play this guessing game. :-} )zaleplon
> > Wel,, she was recommended to me by 2 people she treated for depression, and I notice in her waiting room, there's a lot of info on mental diseases. She may not be exceptional, but it seems like people go to her a lot for depression.
>
> A lot of people go to their GPs for depression. HMOs don't like specialists. I don't think most GPs have much experience treating very severe mental disorders like agitated, psychotic, or melancholic depression, bipolar I, schizophrenia, etc. (Bipolar II is apparently such an all-encompassing category that I'm sure that GPs are now diagnosing and treating it.)Well, I'm in Canada and thank God we don't have HMOs. We can go to any doc we want too. So some GPs kind of specialize through experience and interest. For e.g., my obgyn is really a GP, but all she does is obgyn. She refers you to a real obgyn if needed, but otherwise, I deal with her. And this GP I go to for my depression treats a lot of people for mental illnesses. Of course she'd refer me to a pdoc if my case became more complicated than it is now. I used to have another gp whom I'd go to for colds, the flu or a sprained ankle, but I didn't feel at ease to go to him for my depression - he knows my entire family and that would have been weird. Plus, I'm not sure he has that much experience with depression. Anyway... all this to say the situation here is a bit different than in the US.
> > I never took any drug before except aspirin, birth control pills or antibiotics.
>
> Do you think that had anything to do with your initial reaction to Effexor?From what I read here, the more ADs you took before, the less effect they seem to have. So yes, it might have something to do with my initial reaction to Effexor and the fact that it's effective, even at a low dose. I may be wrong here, but that's something I picked up on by reading posts and reading about ADs in general (although I limited that to a minimum).
> BTW, birth control pills gave me a really bad time (depression relapsed while on Parnate). So I don't think those are necessarily lightweight drugs!
I know, I had to switch brand last spring because I was getting depressive on Diane-35. What I meant is I never took benzos or ADs before. And I've been taking birth control pills recently only (past year) because of major PMS (suicidal 3 days per month).
> "Psychomotricity?" Is that a word? :-)
It is in French anyway. I freely translate sometimes. Psychomotricité.
> Constipation is pretty difficult to manage.Del Montes's prunes in juice work well for me. Oh, and humongous, delicious navel oranges. They're expensive, but MMMMMMMM they're good!
> Yeah, one day we'll all reach OK. (I wonder if the Oklahomans are ready for us? :-} )
lololololol !
Take care, elizabeth. And take your meds. :-)
- sid
Posted by sid on February 9, 2002, at 9:09:33
In reply to Re: depression, etc. » sid, posted by Elizabeth on February 9, 2002, at 0:13:32
I forgot to tell you... increased bruxism was a problem for a while. Now it's not as bad as it was about a month ago. I wear a mouth guard every night, and my jaw does not hurt anymore, so I must not have so much bruxism while I sleep. Otherwise my jaw would hurt even though my teeth would be protected by the mouth guard.
So, another side effect I had to deal with.
Posted by Elizabeth on February 10, 2002, at 12:10:56
In reply to Re: depression, etc. » Elizabeth, posted by sid on February 9, 2002, at 9:03:21
> > > Saw my doc today. She gave me something to help me sleep (fall asleep, has 4 hours of effect only)
> >
> > Ambien? Halcion? (Don't make me play this guessing game. :-} )
>
> zaleplonSonata: that lasts more like 2 hours, I thought. If you wake up early or if your only problem is initial insomnia, I imagine it'd be great -- assuming it works, of course!
> Well, I'm in Canada and thank God we don't have HMOs.
I guess God doesn't like your neighbors down south. :-(
> We can go to any doc we want too.
Here there's a *lot* of variation depending what kind of insurance you have. Medicaid, the state program that disabled people typically get (it's harder to get in some states than others), often covers a lot, but it's common for doctors in private practice not to take it because it doesn't pay them enough.
> So some GPs kind of specialize through experience and interest.
That's cool. I think it's true to an extent here too.
> For e.g., my obgyn is really a GP, but all she does is obgyn.
I think most insurance plans allow you to see an ob/gyn as your "primary care provider."
> She refers you to a real obgyn if needed, but otherwise, I deal with her. And this GP I go to for my depression treats a lot of people for mental illnesses.
So they're both doctors of internal medicine (or whatever you guys call it) by training?
> Of course she'd refer me to a pdoc if my case became more complicated than it is now.
How complicated is it? Have you had a lot of treatment resistance?
> I used to have another gp whom I'd go to for colds, the flu or a sprained ankle, but I didn't feel at ease to go to him for my depression - he knows my entire family and that would have been weird.
Actually, I think it's good for a pdoc to meet your family (I try to introduce my immediate family to my pdocs where feasible), but if he knows them already then that would be kind of odd.
> From what I read here, the more ADs you took before, the less effect they seem to have.
I don't think that's necessarily true of side effects. Also, I think it's more likely that because all of the currently recognized ADs have similar (monoaminergic) mechanisms, if you don't respond to one or two then it becomes quite a bit less likely that others will work for you. (On the other hand, of course, many people who don't respond to SSRUs will respond to MAOIs or TCAs, say, since the different monoamines aren't all the same.)
> I know, I had to switch brand last spring because I was getting depressive on Diane-35.
I tried Ortho-Tricyclen. I decided it wasn't worth it to try a different brand.
> What I meant is I never took benzos or ADs before. And I've been taking birth control pills recently only (past year) because of major PMS (suicidal 3 days per month).
I was taking them to try to prevent cramps (only one or two days but really bad). I think I'm lucky that I don't get any kind of PMS, because it seems like many, maybe most, women do.
> > "Psychomotricity?" Is that a word? :-)
>
> It is in French anyway. I freely translate sometimes. Psychomotricité.Damned Canadians. :-)
> Del Montes's prunes in juice work well for me. Oh, and humongous, delicious navel oranges. They're expensive, but MMMMMMMM they're good!
I'll keep that in mind -- I like navel oranges, although prunes aren't my favorite food (to put it mildly). I've been trying to use Metamucil regularly, but it's a bit of a PITA.
> > Yeah, one day we'll all reach OK. (I wonder if the Oklahomans are ready for us? :-} )
>
> lololololol !I thought that joke was really bad, myself!
> I forgot to tell you... increased bruxism was a problem for a while.
With Effexor, you mean? I think I've heard of that happening with SSRIs and maybe Effexor before.
> Now it's not as bad as it was about a month ago. I wear a mouth guard every night, and my jaw does not hurt anymore, so I must not have so much bruxism while I sleep.
FWIW, I think Klonopin (Rivotril) is supposed to help with that. It's become sort of the standard for movement disorders in sleep.
> Take care, elizabeth. And take your meds. :-)
Yeah, you too :)
-elizabeth
Posted by IsoM on February 10, 2002, at 13:48:55
In reply to Re: depression, etc. » sid, posted by Elizabeth on February 10, 2002, at 12:10:56
> > Del Montes's prunes in juice work well for me. Oh, and humongous, delicious navel oranges. They're expensive, but MMMMMMMM they're good!
>
> I'll keep that in mind -- I like navel oranges, although prunes aren't my favorite food (to put it mildly). I've been trying to use Metamucil regularly, but it's a bit of a PITA.TCAs caused me terrible constipation. I found two foods were better than any others for mine. Have either of you ever tried eating raw brocolli stalks? I LOVE the taste & can munch on them all day like some people do peanuts or celery. Very high in fibre & it's quite gentle too. The other is any sort of dried beans. Not everyone likes beans but again I love them too. Beans is another very high fibre food & lots of soluble fibre. Just a suggestion.
Posted by sid on February 10, 2002, at 15:34:14
In reply to Re: depression, etc. » sid, posted by Elizabeth on February 10, 2002, at 12:10:56
> > zaleplon
> Sonata: that lasts more like 2 hours, I thought. If you wake up early or if your only problem is initial insomnia, I imagine it'd be great -- assuming it works, of course!
Different name here of course (Starnoc). It's 10mg, so perhaps it's a higher dosage than Sonata, which would explain it potentially lasting longer. And yes it works. I took it last night and finally went to sleep thanks to it!
> > She refers you to a real obgyn if needed, but otherwise, I deal with her. And this GP I go to for my depression treats a lot of people for mental illnesses.
>
> So they're both doctors of internal medicine (or whatever you guys call it) by training?No. The GP does not have an actual doctorate (calling medical providers "doctor" is often wrong). Those who specialize (5-10 more years in school) have an actual doctorate. "Real" obgyn's do that. My GP who only does obgyn-related consultations refers you to a "real" obgyn if you are a more complicated case. You go to her for annual exams, uncomplicated pregnancies, usual stuff.
> > Of course she'd refer me to a pdoc if my case became more complicated than it is now.
>
> How complicated is it? Have you had a lot of treatment resistance?No resistance (except my own resistance to take meds for a long time!). I've responded to therapy, acupuncture and now to Effexor XR. Yoga is helping me with the anxiety these days; I started a class a few weeks ago and I love it. I cross my fingers that I continue to respond well to the meds.
> Actually, I think it's good for a pdoc to meet your family (I try to introduce my immediate family to my pdocs where feasible), but if he knows them already then that would be kind of odd.
Not my family. There are people in my family who like nothing better than to put me down, I'm not about to tell them the story of my life. I've learned to grow and live despite my family.
> I think I'm lucky that I don't get any kind of PMS, because it seems like many, maybe most, women do.Not all women do, not all as bad as me. How old are you? It's new to me... I'm 34 and apparently, PMS is the worse in a woman's 30's. I used to have cramps a few times a year, but this hormone-driven suicidal thing, that's 2 years old, no more.
> I'll keep that in mind -- I like navel oranges, although prunes aren't my favorite food (to put it mildly). I've been trying to use Metamucil regularly, but it's a bit of a PITA.
PITA? Prunes are good with vanilla yogourt. Alone, they're not great.
> > > Yeah, one day we'll all reach OK. (I wonder if the Oklahomans are ready for us? :-} )
> >
> > lololololol !
>
> I thought that joke was really bad, myself!
Well I'm not American, so I would not have thought of it myself. Surprise effect.> With Effexor, you mean? I think I've heard of that happening with SSRIs and maybe Effexor before.
Yes. I have bruxism to start with, and it was (is still perhaps?) worse with Effexor XR.
> FWIW, I think Klonopin (Rivotril) is supposed to help with that. It's become sort of the standard for movement disorders in sleep.
Yes, trying to avoid benzos. My doc is reluctant and me too. I find that I already take enough meds. Roght now I do well with the mouth guard only, we'll reassess if needed later. At least now I'm done taking meds for my allergy (I ate some mussel sauce by mistake on Thursday and had to take lots of Immodium and Gravol in order for my body not to react too strongly). Back to Effexor XR, Allesse, Starnoc if needed, and vitamins. I hate to take meds and can't wait to be free of them.
Bye...- sid
Posted by sid on February 10, 2002, at 15:35:54
In reply to Elizabeth and Sid..., posted by IsoM on February 10, 2002, at 13:48:55
> TCAs caused me terrible constipation. I found two foods were better than any others for mine. Have either of you ever tried eating raw brocolli stalks? I LOVE the taste & can munch on them all day like some people do peanuts or celery. Very high in fibre & it's quite gentle too. The other is any sort of dried beans. Not everyone likes beans but again I love them too. Beans is another very high fibre food & lots of soluble fibre. Just a suggestion.
Thanks, IsoM. I know about these other sources of fiber. I do eat them from time to time, but not everyday; unlike oranges when they are available...... MMMMMMMMMMMM !
Posted by Elizabeth on February 13, 2002, at 18:21:29
In reply to Re: depression, etc. » Elizabeth, posted by sid on February 10, 2002, at 15:34:14
> Different name here of course (Starnoc). It's 10mg, so perhaps it's a higher dosage than Sonata, which would explain it potentially lasting longer.
No, I think Sonata comes in 10's....
> And yes it works. I took it last night and finally went to sleep thanks to it!
Cool. I haven't heard too many success stories about it, so it's nice to know somebody finds it helpful!
> No. The GP does not have an actual doctorate (calling medical providers "doctor" is often wrong). Those who specialize (5-10 more years in school) have an actual doctorate. "Real" obgyn's do that. My GP who only does obgyn-related consultations refers you to a "real" obgyn if you are a more complicated case. You go to her for annual exams, uncomplicated pregnancies, usual stuff.
This is pretty confusing! Here's our system: often, people see a nurse practitioner or physician's assistant (a "mid-level provider") as their primary care provider (HMOs are happy to recognize mid-level providers as PCPs, since they generally cost less to see than physicians do). I believe that mid-level providers can write some prescriptions; I don't know exactly how it works. There are also internists (doctors of internal medicine) and family doctors (family medicine; I don't know exactly how this is different from internal medicine) who aren't specialists and who generally act as PCPs, but who have more training than nurse practitioners or PAs. Some HMOs will also let women see their ob/gyn as a PCP. Usually if you belong to an HMO (and I think that Medicaid -- state-paid insurance for disabled people, the closest thing we have to nationalized health care -- is run like an HMO in most states), you have to get a referral from your PCP in order to see a specialist like a psychiatrist, dermatologist, cardiologist, etc. So for example, an internist or nurse practitioner would probably be comfortable treating an uncomplicated case of depression with one of the newer ADs or perhaps a TCA, but at some level of complicatedness (depending on the individual PCP's experience) -- psychotic features, mania, treatment resistance, suicidality, need for multiple medications, etc. -- the PCP would want to refer the patient to a psychiatrist. The last time I had a PCP was when I was living in Boston; I was seeing a resident in internal medicine at the clinic at one of the Harvard-affiliated teaching hospitals.
> No resistance (except my own resistance to take meds for a long time!). I've responded to therapy, acupuncture and now to Effexor XR.
Ahh, okay. I don't think that PCPs here typically do talk therapy or acupuncture, but I wouldn't expect you to get referred to a psych if you were seeing a PCP here.
> Yoga is helping me with the anxiety these days; I started a class a few weeks ago and I love it. I cross my fingers that I continue to respond well to the meds.
Crossing mine for you too. :-)
> Not my family. There are people in my family who like nothing better than to put me down, I'm not about to tell them the story of my life.
Oh, I didn't mean that! I meant that meeting a patient's family can give the therapist an idea of what kind of atmosphere the patient is living in, or grew up in. Doesn't mean that they sit in on all your therapy sessions! (And I would expect a therapist to know better than to take everything that the family says as gospel.)
> I've learned to grow and live despite my family.
Ack. How come there seem to be so many people who have/had awful relationships with their families? Is this just to be expected, or is it a societal problem, or what?
> Not all women do, not all as bad as me. How old are you?
25.
> It's new to me... I'm 34 and apparently, PMS is the worse in a woman's 30's.
Yikes.
> I used to have cramps a few times a year, but this hormone-driven suicidal thing, that's 2 years old, no more.
Huh. Weird that something like that would start in your 30's. I do get bad cramps, but that's on day 1 (occasionally day 2 as well), not premenstrual, and there aren't any associated mood symptoms.
> PITA?
"pain in the *ss"
> Prunes are good with vanilla yogourt. Alone, they're not great.
I'm not convinced that *anything* would make prunes much better than "slightly tolerable" to me! :-} I'll stick with the Metamucil (every doctor I've talked to about my problem seems to take Metamucil every day, so I figure it probably won't kill me, at least).
> Yes, trying to avoid benzos. My doc is reluctant and me too. I find that I already take enough meds. Roght now I do well with the mouth guard only, we'll reassess if needed later.
Do you ever find that your mouth hurts from clenching? I've never had bruxism myself (at least, not that I know of), but I have had jaw pain a couple of times and it was very distracting/irritating. I think if I had that problem often I'd want to be able to do something about it. A mouth guard does help with most of the problems that are usually associated with bruxism, though, and it's certainly a better choice for nightly use. (Kind of unsexy if you happen to be spending the night with somebody, though!)
> At least now I'm done taking meds for my allergy (I ate some mussel sauce by mistake on Thursday and had to take lots of Immodium and Gravol in order for my body not to react too strongly).
That sounds dreadful. Please spare me the details. :-} Seriously, I hope you're feeling okay now.
> Back to Effexor XR, Allesse, Starnoc if needed, and vitamins. I hate to take meds and can't wait to be free of them.
How are vitamins different, effectively? I don't take any vitamin or mineral supplements unless I have some specific need for them (like anemia or something) -- those pills are huge. I prefer good old-fashioned food when I'm feeling okay, and when I'm depressed -- hopefully, never again -- "not taking vitamin supplements" is pretty low on the list of ways that I fail to take care of myself.
-elizabeth
Posted by sid on February 13, 2002, at 22:50:19
In reply to Re: depression, etc. » sid, posted by Elizabeth on February 13, 2002, at 18:21:29
> This is pretty confusing! Here's our system:...
Here, we don't have APs, and nurses can't give prescriptions, although that will change in a few years I think. We see general practitioners (GP), who are sometimes called family doctors. They give us referrals to specialists when needed. Or we can see specialists without referrals, but it takes longer, since patients with referrals have priority.
> > No resistance (except my own resistance to take meds for a long time!). I've responded to therapy, acupuncture and now to Effexor XR.
> Ahh, okay. I don't think that PCPs here typically do talk therapy or acupuncture, but I wouldn't expect you to get referred to a psych if you were seeing a PCP here.My GP treats me for dysthymia and anxiety: some CBT (suggests that I do things that may help) and talk in order to figure out how I'm doing. She prescribes meds.
Therapy was done with psychologists and acupunture with an acupuncturist. Neither were medical doctors. I saw these specialists while in the US, where I lived several years. I decided to see a medical doctor recently, in Canada, to get meds and attempt to finally (I hope!) be free of mental illness. I have not found an acupuncturist to treat my depression here, I really miss the one I had in the US. And I've dome all the therapy I care for, for now at least. Since I had trouble dealing with stress (anxiety) and I still had dysthymia, I went to see a GP. Had I had access to my US acupunturist, I would probably have continued with her. But no luck finding a replacement.
> Ack. How come there seem to be so many people who have/had awful relationships with their families? Is this just to be expected, or is it a societal problem, or what?Don't know. I feel like Lisa Simpson: I look at my family, and I can't believe I'm one of them. Family reunions are very stressful for me. That was the good thing about living in foreign countries for several years: I never saw them! Actually, I get along well with my mom; it's my sister and my in-laws I can't stand. My sister's husband especially since he has sexually harrassed and molested me since I was about 8 (he's 20 years older than me). And many other things that bother me, but his behavior towards me is what bugs me most.
> Huh. Weird that something like that would start in your 30's. I do get bad cramps, but that's on day 1 (occasionally day 2 as well), not premenstrual, and there aren't any associated mood symptoms.Don't know why... I was told by 2 doctors of mine and some older women who had PMS that it's worse in one's 30's. It's certainly true for me so far.
> Do you ever find that your mouth hurts from clenching? I've never had bruxism myself (at least, not that I know of), but I have had jaw pain a couple of times and it was very distracting/irritating. I think if I had that problem often I'd want to be able to do something about it. A mouth guard does help with most of the problems that are usually associated with bruxism, though, and it's certainly a better choice for nightly use. (Kind of unsexy if you happen to be spending the night with somebody, though!)My jaw hurts sometimes, the joints on both sides especially. Although these days that's OK. But I have bruxism during the day too! The other day I bit my tongue while watching TV!!! I try to keep my mouth open a bit in order to avoid clenching my teeth all day. A custom made mouth guard is supposed to last about 2 years, but mine will barely last 1 year... the other night I was dreaming that I was chewing something. I woke up and I was trying to chew my mouth guard! :-) Sometimes I have to take it out though because it makes me nausceous (sp?) from time to time. Anyway, if you have bruxism, I think it's a good investment. And regardless of the pain in the jaw joints, it does protect you teeth. I must say I had bruxism before though; it's just worse with Effexor XR. I even broke a tooth during my major depression in 1995 - that was the worse bruxism I had.
> That sounds dreadful. Please spare me the details. :-} Seriously, I hope you're feeling okay now.Yes, I did not suffer much allergy reactions this time. Last time I had mussels (before I knew I had become violently allergic), I thought I would die. Thank God I ran to a pharmacy and saw to it that my body was put on "neutral" for a few days. It worked; I wasn't sure it would. I never had allergies before, it's weird.
> How are vitamins different, effectively? I don't take any vitamin or mineral supplements unless I have some specific need for them (like anemia or something) -- those pills are huge.Different from meds? Well, for one thing I have no side effects from them! I just take Centrum each day, especially in the Canadian winter, which is dang tough on our bodies (and minds too!).
Take care.
- sid
Posted by mdmicky on March 2, 2002, at 14:55:10
In reply to Re: MAOI diet short list, posted by Lisa01 on January 14, 2002, at 20:46:11
i'm a psychiatrist.
i've been on parnate for just over 6 yrs. i take 60 mg/d. i've never had a relapse and i think it's a great medication.
for the first three years i didn't cheat at all on the STRICT diet. then i started cheating bit by bit until eventually i stopped observing a diet at all. i must admit that i drink draft beer (all sorts including local microbrews and in fairly large quantities), red wine, and all sorts of cheeses. i don't like kraut or liver so i haven't had those. because i work very long days and rarely have time for lunch or dinner, i also eat several LUNA bars or Harvest bars every day. i never thought to look for soy...
i also have to say, of course, that being a doctor i'm definitely not as careful as i should be and i don't check my blood pressure very often. also, my pressure normally runs 90s/50s so i have some room for increase without consequence.
i wouldn't advise my "restriction-free" diet to any of my patients (and i do prescribe parnate occasionally) or to any of you. i only learned of this site because one of my partners sent me the link as he, too, finds my diet a bit reckless and foolish. in any case, i thought i'd at least pass along my experiences.
and elizabeth, thanks for the list that started this thread, i may use it for my patients as i've had difficulty makeing a list that was balanced.
Posted by Bobbiedobbs on March 23, 2002, at 13:33:03
In reply to Re: MAOI diet short list, posted by mdmicky on March 2, 2002, at 14:55:10
I have taken Nardil (30-45 mg.)for 15 years and Parnate (20-30 mg) for about two. I think Elizabeth's short list comes the closest I've seen to being accurate, and least as far as my own experience. I observed the crazy dietary restrictions for the first 10 years or so, then, on the advice of Dr. Shulman and others' studies, began consuming some of the items for which their appeared to be only anecdotal evidence - i.e. evidence without any basis in actual tyramine content/absorption studies.
This is my experience: On the above drug regimens I have consumed the following foods regularly (as above as several times a week for 7 years), without the SLIGHTEST side effect:
Pizza with mozzarella cheese.
Ricotta
Yogurt.
Beer - bottled, canned, domestic and exported - up to 3 per four hours.
White wine, red wine (in quantities) hard liquor.
Sausage, pepperoni - mostly on pizza.
Sauerkraut - in the U.S. and France.
Soy sauce - all sorts of brands and in Chinese restaurants - generally small quanities.
Processed American (Kraft) cheese slices.
Chocolate, raspberries, etc.
The only time I had a side effect was when I mistakenly took a decongestant. I got a terrible headache, was sweating and my blood pressure was way high. I went to the hospital, they gave me Mellaril, and I was discharged.
I have heard that absorption rates and sensitivity can vary among users. Yet the fact that I have been able to consume these for so many years without ANY measureable effect would at least give pause for doubt.... think the shame of the whole thing is that these medications can be enormously helpful (they have been to me) but doctors won't prescribe them becuase of the food restrictions, which, in this individuals's opinion, and except for the hard cheeses, other medications and a few other oddball items, are largely bogus. Phil.
Posted by djmmm on March 25, 2002, at 17:31:49
In reply to Re: MAOI diet short list, posted by Bobbiedobbs on March 23, 2002, at 13:33:03
I couldn't agree more. When the "list" was originally created, all food that contained tyramine was restricted, regardless of content, etc.
The MAOI diet is based on poor scientific evidence, and shouldn't be a factor when deciding depression treatment.
Posted by djmmm on March 26, 2002, at 9:52:50
In reply to Re: MAOI diet short list, posted by Bobbiedobbs on March 23, 2002, at 13:33:03
From
http://www.vh.org/Providers/Conferences/CPS/19.htmlA retrospective analysis of the incidence of acute hypertensive crisis in 692 patients treated with MAOIs found that the incidence was 8.4% prior to instituting dietary restrictions but 3.3% after dietary restrictions were imposed (Bethune 1964). In the Rabkin chart review (1985) study, 11 patients (8%) on phenelzine and one patient (2%) taking tranylcypromine experienced hypertensive reactions.
The Rabkin, et al study included 198 patients
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=6386898&dopt=Abstract
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=3973068&dopt=Abstract
Posted by Elizabeth on March 26, 2002, at 18:44:40
In reply to Re: MAOI diet short list, posted by djmmm on March 25, 2002, at 17:31:49
> I couldn't agree more. When the "list" was originally created, all food that contained tyramine was restricted, regardless of content, etc.
It's even worse than that. There were also foods that don't contain significant amounts of tyramine (or other biogenic amines); they were included based on old and flawed techniques for measuring the tyramine content (such as Chianti), vague and poorly documented case reports (e.g., chocolate), etc., as well as foods that were simply related to foods that were known (or believed) to interact with MAOIs (for example, based on putative interactions with a few types of alcoholic drinks, the recommendation was made that people avoid *all* alcoholic drinks).
The effect of all this has been (not surprisingly) much like the effect of telling kids that marijuana is a highly dangerous and addictive drug: once people realize that they can "cheat" on the diet, they don't take *any* of the recommendations seriously -- even the ones that really should be taken seriously.
> The MAOI diet is based on poor scientific evidence, and shouldn't be a factor when deciding depression treatment.
Well, the old MAOI diets are (there are many, many different versions). That's why some Canadian researchers went and did the actual research to figure out which foods actually should be avoided. (This research is the main basis for my version of the dietary restrictions list.) There are still doctors out there who use one of those invalid lists that contain a lot of foods that shouldn't be included, though. Educate them, everybody! :-)
-elizabeth
Posted by LLL on July 13, 2002, at 12:40:18
In reply to Re: MAOI diet short list, posted by mdmicky on March 2, 2002, at 14:55:10
I am on Parnate again after a 4 year break and am not remembering some of the diet restricitons. Is canned tuna OK? what about the use of Lipton soup mixes (the dried variety) for cooking? Is everything with yeast extract and soy protein out? I haven't heard anything mentioned of MSG, isn't that a big no-no?
Posted by Bobbiedobbs on July 14, 2002, at 23:18:38
In reply to Re: MAOI diet short list, posted by LLL on July 13, 2002, at 12:40:18
To answer your question, canned tuna is fine, same with lipton's soup mix. I never had any particular problem with MSG and don't know of any. Yeast extract I guess is a no-no. Regarding soy protein, I recently had an extensive dialogue with the folks at the company that makes Parnate (Glaxo) concerning a variety of soy=based products. Rather than commit to memory I will find my notes later this week and post. The general rule was soy was OK but fermented soy was not, and that included a lot. You have to keep in mind that these are the folks who say you can't have chocolate or yogurt! Will post what company doctors said vis-a-vis soy. If you look at some of the earlier messages, I think Elizabeth had a good post on soy products.
Posted by LLL on July 15, 2002, at 10:08:03
In reply to Re: MAOI diet short list, posted by Bobbiedobbs on July 14, 2002, at 23:18:38
> To answer your question, canned tuna is fine, same with lipton's soup mix. I never had any particular problem with MSG and don't know of any. Yeast extract I guess is a no-no. Regarding soy protein, I recently had an extensive dialogue with the folks at the company that makes Parnate (Glaxo) concerning a variety of soy=based products. Rather than commit to memory I will find my notes later this week and post. The general rule was soy was OK but fermented soy was not, and that included a lot. You have to keep in mind that these are the folks who say you can't have chocolate or yogurt! Will post what company doctors said vis-a-vis soy. If you look at some of the earlier messages, I think Elizabeth had a good post on soy products.
More questions - what about the use of vinegar? distilled white vinegar, rice vinegar, tarragon white whine vinegar as well as Marsala cooking wine and sesame oil. Can these be safely used during cooking while on Parnate?
Posted by LLL on July 15, 2002, at 14:57:33
In reply to Re: MAOI diet short list, posted by Bobbiedobbs on July 14, 2002, at 23:18:38
Thank you for your response. After taking a closer look at the dry packaged Lipton Soup Mix box as well as the cans of Swansons beef and chicken broth, they all contain yeast extract and or autolyzed yeast extract and thus sound like they should be prohibited. I used to use both a lot in my cooking. I also noticed a can of re-fried beans that I have contains autolyzed yeast extract. I always remember before while on Parnate ('93-'97), looking out for MSG but never yeast extract. I'd appreciate you getting back to me on the soy protein and soy flour as I don't eat meat (just turkey/chicken/fish) and some of the convenience foods and snacks I use contain these.
I also have a question about "leftovers". If I make a meal with turkey/chicken one night, I cannot have it again the next? Also, what about marinating meat for several hours in the fridge (I make my own marinade) before cooking?
As you can see I'm very anxious about starting this medication again and having a hypertensive crisis. Thanks.
Posted by Bobbiedobbs on July 16, 2002, at 0:23:58
In reply to Re: MAOI diet short list, posted by LLL on July 15, 2002, at 14:57:33
I happened to be exploring vegetarianism and posed the question of food tolerances to specialist at GlaxoSmithKline, the company which manufacturers Parnate. He told me to refrain from the following: Tofu, Tempeh, Tamari Sauce, soy sauce and any kind of fermented soy bean product or fermented bean curd (PLUS mISO SOUP!!) I'd just note here that others who have posted on this site have said that tofu (if not fermented) was OK. While your doctor or pharmacist should be able to answer questions, I've found the folks at GlaxoSmithKline to be very helpful. The Customer Service Line 1-888-825-5249.
I've taken Nardil (another MAO) and Parnate for years and never had a problem with any type of cooking vinegar or sesame oil. Marsala wine, strictly speaking, is on the no-no list but I've had Marsala wine and sauce without any problem.
For the first several years when I was taking an MAO I watched my diet like a hawk. I loosened the food restrictions considerably after reading several studies published in the Journal of Clinical Psychiatry (March, 1996) and Lancet. These studies actually measured tyramine content and did exhaustive reviews of literature. The conclusion was that MAOI diets were excessively restrictive and founded on poor scientific evidence. They recommend users avoid aged cheeses, aged or cured meats, potentially spoiled meats, broad bean pods, yeast extract, sauerkraft, soy sauce and 'soy bean condiments" but considered wine (red or white) and domestic or bottled beer safe in moderation (as well as mozzarella and processed american cheese!). Anyway, on the foods of interest to you, they (David Gardner, Kenneth Shulman, Scott Walker and Sandra Tailor, Dpt. of psychiatry, Sunnybrook health Science Centre, Toronto, Canada state the following:
"Other yeast extracts (e.g. brewer's yeast) contain no significant amounts of tyraminE nor do (MSG) or gravies made from fresh stock and or beef or chicken bouillon. As to yeast extract, the Univ. of Toronto diet lists "marmite concentrated yeast extract" as "food to avoid" but "other yeast extracts, e.g. brewer's yeast," as "food allowed". Soy milk is also specifically on the allowed list.
Eating leftovers is no problem as long as the food itself is safe, is adequately refrigerated and there has been no spoilage or post-preparation aging.
In all the years I and a handful of other people I know have taken these medications, the only severe reactions have occurred from aged cheese on a pizza and from a decongestant.
Hope this helps more than confuses. It's too bad that these meds are so restrictive but if you can get the hang of them, they can be extremel helpful - actually worth it. Nardil, at least, helped me tremendously. Good luck! Phil
Posted by cybercafe on July 16, 2002, at 2:29:33
In reply to Re: MAOI diet short list, posted by Bobbiedobbs on July 16, 2002, at 0:23:58
>GlaxoSmithKline to be very helpful. The Customer Service Line 1-888-825-5249.
Awesome... someone said elizabeth called and found they measured the tyramine in different types of soy sauce, is that right?
>(David Gardner, Kenneth Shulman, Scott Walker and Sandra Tailor, Dpt. of psychiatry, Sunnybrook health Science Centre, Toronto, Canada state the following:
ah yes sunnybrook... i'm sure the pdocs are above average there... also a hospital with an emergency ward known to interview and turn away psychotic and suicidal patients... currently at least one law suit against them i know of ...
... too bad you have to suffer permanent and severe injuries to be able to charge someone who is obviously wrong...
<rant off>
Posted by KellyM on July 16, 2002, at 8:55:32
In reply to Re: MAOI diet short list, posted by Bobbiedobbs on July 16, 2002, at 0:23:58
Thank you for putting down your thoughts here... I found them helpful. Nardil is helping me :-)
Posted by LLL on July 16, 2002, at 10:21:15
In reply to Re: MAOI diet short list, posted by Bobbiedobbs on July 16, 2002, at 0:23:58
Thank you sooooooooo much! I've been on Parnate before (found it to have less side effects than Nardil) and it was a miracle drug for my panic disorder and agoraphobia. I'm hoping it will help again. Thank you so much for all your helpful advice!
Lisa
Posted by jsarirose on July 16, 2002, at 14:27:04
In reply to Re: MAOI diet short list » Bobbiedobbs, posted by LLL on July 16, 2002, at 10:21:15
RE: MAO Diet
Keep in mind that the lists were re-done in 1996. Take any information from lists pre-1996 with a grain of salt. There are a lot of things that were previously prohibited that are now found to be fine.
General rule of thumb is aged products - that doesn't mean self-aged as in leftovers & marinades. You have to be a little careful with fruits and vegetables and leftovers that they aren't too far gone, but that's basically true anyway.
I had a hard time finding soups and broths without autolyzed yeast as well. Check out some Asian mixes and the more expensive pure boullions.
Vinegar is fine, as is soy sauce in moderation (1 tbsp or so at most). Tofu is fine, but not tempeh as it is fermented.
And don't forget that many cold meds are also not allowed!
Fresh cheeses are allowable, as in: mozzarella, montrachet, chevre, ricotta, cottage, cream cheese, etc. (Mozzarella has been a life saver for me as I'm a cheese-aholic!)
And the item about beer is general, tap beers or micro-brews can be dangerous, but big brand, pasteurized beer is fine.Here are some sites I found helpful:
http://www.holisticonline.com/Remedies/Depression/dep_interactions_MAOI.htm
http://www.urmc.rochester.edu/miner/docs/pated/drugshts/mdiet.html
http://health.wchsys.org/carenotes/nd2007g.htmGood luck!
-Jessica
Posted by cybercafe on July 16, 2002, at 14:55:23
In reply to Re: MAOI diet short list, posted by jsarirose on July 16, 2002, at 14:27:04
anyone with a non-pre-existing blood pressure condition have any hypertensive experiences they'd like to share.... especially those on lower doses (i'm on 30 mg of parnate, and eat pepperoni pizza with no probs) ...
Posted by LLL on July 16, 2002, at 16:22:57
In reply to Re: MAOI diet short list » Bobbiedobbs, posted by KellyM on July 16, 2002, at 8:55:32
re: calling Glaxo Smith Kline for info on food restrictions with Parnate. Called today and they could not give me any info other than what is on the package insert. They told me only a health care provider would be able to discuss things further. My pharmacist was gracious enough to call for me with my list of questions and was told they would fax her the responses. After waiting all day, she received a fax stating she could look up two articles to read!
What clout do you all have, or what is the magic word enabling you to reach these experts?!
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