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Dr. Bob is Robert Hsiung, MD,
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Posted by fierc on August 15, 2002, at 0:37:12
In reply to Re: MAOI diet -, posted by cybercafe on August 14, 2002, at 12:06:48
> > I can't believe how many times I've heard this! You should have an emergency pill - I take Chlorpromazine (Thorazine). It is safe, it works, and you can take it even if you aren't sure if your blood pressure is spiking.
>
> ... maybe your case is different because you were taking a super duper high dose? ....
>
> or perhaps most docs think that if you are in serious trouble you shouldn't be treating it yourself (but should go to the emergency ward instead)...
>
> if fierc is in canada or another socialized medical system like myself (i assume so, if he's taking moclobemide) it's probably more practical (read: affordable) to go to an emergency ward than in the states <showers mrs. rosenberg with sympathy for having to pay for medical help>
>
> > And if you're on Parnate, you should be adhering to the diet restrictions. I don't know why your doctor thinks you can ignore them. It's true the current lists are more lax than the ones prior to 1996, but you still need to stay away from certain foods. You may ask him why he thinks you won't have hypertensive crisis if you eat one of the items.
>
> ... i assume when he says "ignore them", he means ignore them and instead follow a more basic list his doc provided
>
> ... i think any doc who is hardcore enough to prescribe an MAOI is probably also competent enough to know the risks
>
>
My so-called diagnosis is atypical depression, however I mostly suffer from anxiety....my dr. hasn't made a clear statement about what it is. I have a lot of problems with my dr. Not to make him sound so aweful. I just get extremely frustrated because I ask educated questions and he just gives me the blow off as little girl doesn't know what she is talking about, just cause she learned a couple of things in university.....He is famous for pulling me off meds after 2 weeks even after I object and put me on others. Luckily I have good health coverage since I'm still in university.
I guess I'm just going to have to annoy the man and ask many more questions....is there anything i'm missing that i should know about other than diet and hpyertensive crisis'?? Let me know....More I can learn I'd be thrilled!
Posted by jsarirose on August 15, 2002, at 0:47:58
In reply to Re: MAOI diet -, posted by fierc on August 15, 2002, at 0:37:12
> My so-called diagnosis is atypical depression, however I mostly suffer from anxiety....my dr. hasn't made a clear statement about what it is. I have a lot of problems with my dr. Not to make him sound so aweful. I just get extremely frustrated because I ask educated questions and he just gives me the blow off as little girl doesn't know what she is talking about, just cause she learned a couple of things in university.....
>
> He is famous for pulling me off meds after 2 weeks even after I object and put me on others. Luckily I have good health coverage since I'm still in university.
>Do you have any option of seeing someone else? He sounds awful. He may have some good knowledge, but attitude is very important when dealing with depressed patients! I would not be able to stand for being talked down to. And the bells really go off when he wants to take you off meds so quickly. Especially when you have treatment resistant depression it is very important to give meds a full run and even push them to higher than normal levels. I have had depression for 25 years - that's an awful lot of drugs to go through. It isn't really a test of a drug unless you give it a full run (unless the side effects are too bad). You don't want to have to go back to a drug you've already tried and test it again - you waste a lot of time that way.
And I just don't know what to say about the MAOI advice he gave you. I would try to pin him down on the why's of no diet restrictions and no emergency pill.
If I don't have a good feel from a doctor, I try someone new. It's my life I'm playing with!
-Jessica
(Did I give you the site for Treatment Resistant Depression and the suggested medication route? If not, check out: http://www.acnp.org/g4/GN401000105/Default.htm
Posted by LLL on August 15, 2002, at 10:01:16
In reply to Re: MAOI diet -, posted by jsarirose on August 15, 2002, at 0:47:58
After failing with the Parnate I'm going to ditch AD's for now. How long must I wait before starting vitamin mega therapy including Omega 3 fish oil, and gamma-aminobutyric acid (GABA)? I also plan on resuming St. John Wort, something that helped me maintain fairly well for 4 yrs following cessation of Parnate in the past.
What period of time do I need to wait on the vitamins and supplements? and how long for the St. John Wort?Thanks,
Lisa
Posted by jsarirose on August 15, 2002, at 14:41:19
In reply to Wash Out period » jsarirose, posted by LLL on August 15, 2002, at 10:01:16
> After failing with the Parnate I'm going to ditch AD's for now. How long must I wait before starting vitamin mega therapy including Omega 3 fish oil, and gamma-aminobutyric acid (GABA)? I also plan on resuming St. John Wort, something that helped me maintain fairly well for 4 yrs following cessation of Parnate in the past.
> What period of time do I need to wait on the vitamins and supplements? and how long for the St. John Wort?
>
> Thanks,
> LisaWow - sorry the Parnate didn't work out. I'm glad you have some other options that might work for you and it sounds like you're keeping your spirits up, at least you're still hopeful. And being hopeful is the most important thing for us - it lets us keep trying.
Unfortunately I have no advice on either of your questions since I'm not personally familiar with either option. But I wish you luck.
-Jessica
Posted by LLL on August 15, 2002, at 15:59:05
In reply to Re: Wash Out period, posted by jsarirose on August 15, 2002, at 14:41:19
Although I may sound hopeful, actually I'm not. I see a bleak future of living within a 5 mile radius of my home.
Posted by jsarirose on August 15, 2002, at 16:35:40
In reply to Re: Wash Out period » jsarirose, posted by LLL on August 15, 2002, at 15:59:05
> Although I may sound hopeful, actually I'm not. I see a bleak future of living within a 5 mile radius of my home.
Well, please keep us informed about how you're doing. And don't give up - I tried almost every drug in the book before I found Parnate. Don't underestimate therapy (if you can find a good therapist - sometimes not so easy). At the very least it can help you to stay hopeful. Feel free to email any time (jsarirose1@attbi.com).
Take care,
Jessica
Posted by Bobbiedobbs on September 8, 2002, at 13:44:01
In reply to Re: Jess -- update, posted by jsarirose on August 7, 2002, at 1:14:44
I'm curious whether any of the MAO users experimented with any of the cheeses and/or soy products mentioned as "OK" in the 1999 Sunnybrook study. I remember Jess talking about some preliminary trials with feta and goat cheese. While I was away I got a copy of the Kenneth Shulman study on the tyramine content of pizzas and soy products alluded to by a prior poster. While the study relaxes prohibitions on cheese (extending the OK to double cheese/double pepperoni pizzas from the major pizza chains) it is quite restrictive on all soy products, including any tofu. I have put soy sauce on my chinese food for years without any ill effect. I'm speculating that the soy sauce commonly used in the US is a bastardized, weakened version. Welcome all replies. Phil.
Posted by jsarirose on September 8, 2002, at 14:27:53
In reply to MAO cheese, soy, etc followup, posted by Bobbiedobbs on September 8, 2002, at 13:44:01
> I'm curious whether any of the MAO users experimented with any of the cheeses and/or soy products mentioned as "OK" in the 1999 Sunnybrook study.
Well I tried the feta with no problems at all. And I've been eating soy sauce and tofu all along trouble-free. I really wanted to continue trying some of the other cheeses they mentioned that previously were thought to be off-limits. I think brie (without the rind) was on there and perhaps Gruyere? I can't for the life of my find where I saw the list online though. Can you point me to the site again, and I'll be happy to guinea pig myself with cheese! All in the name of science (and happy taste buds) of course.
Thanks,
Jessica
Posted by LLL on September 8, 2002, at 15:46:21
In reply to Re: MAO cheese, soy, etc followup » Bobbiedobbs, posted by jsarirose on September 8, 2002, at 14:27:53
Here's the link I posted earlier with the tyramine content of the cheeses:
http://www.vh.org/Providers/Conferences/CPS/19.html
It's towards the end of the document.
Posted by jsarirose on September 8, 2002, at 15:57:19
In reply to Re: MAO cheese, soy, etc followup » jsarirose, posted by LLL on September 8, 2002, at 15:46:21
> Here's the link I posted earlier with the tyramine content of the cheeses:
> http://www.vh.org/Providers/Conferences/CPS/19.html
> It's towards the end of the document.Thank you! I was looking everywhere for it! I volunteer to try Muenster & Swiss Gruyere. I'll be unbelievably happy if I can expand my cheese choices. (Obviously an honorary Canadian cheesehead.)
-Jessica
ps - who is going to volunteer to test the "19-104 beers" necessary to provoke an attack?
Posted by LLL on September 8, 2002, at 16:24:50
In reply to Re: MAO cheese, soy, etc followup, posted by jsarirose on September 8, 2002, at 15:57:19
Good Luck Jessica! Sorry I won't be able to experiement with foods with you since I've dropped out of the MAOI club and joined the Benzo club!
Posted by utopizen on September 8, 2002, at 16:27:38
In reply to Re: MAO cheese, soy, etc followup, posted by jsarirose on September 8, 2002, at 15:57:19
Soya and tofu aren't the same thing. Tofu is processed soya (or "soy").
That would like calling milk and cheese the same thing. Yeah, they're both dairy, but one's processed.
Posted by Bobbiedobbs on September 8, 2002, at 18:41:25
In reply to Re: MAO cheese, soy, etc followup, posted by jsarirose on September 8, 2002, at 15:57:19
Jessica: The list to which I was referring is from a separate report, "Refining the MAOI DIET: Tyramine Content of Pizzas and Soy Products" by Kenneth I. Shulman M.D and Scott Walker, M.Sc.Pharm (3/1999) and a subsequent report, "A reevaluation of Dietary Restrictions for Irreversible MAOs" by the same guys, dated 06/2001. I don't know if this was ever posted online but I learned of it from one of the prior posters and got it by mail. Per that report, the bottom line on some of the foods in question is:
Foods with per serving/tyramine content well below the conservative 6 mg/serving danger level:
Sargento Light Italian, Aged Romano cheese, Ziggy's feta cheese (like that name!) and mozzarella. In the pizza category: double cheese/double pepperoni pizzas from Domino's, Pizza Pizza, Pizza Hut and McDonalds; three common Worcestershire sauces. Of 5 soy sauces tested, only Pearl River Bridge soy sauce presented any problem. They tested a whole mess of wines, all of which registered tyramine levels well below concern (you'd have to have 12 servings of the worst of them - a Spanish red - to reach a level of concern. The Chiantis that were tested didn't prove to be a problem.
Yes, I'm interested in you being the king's tester for the cheeses mentioned in the other report which Lisa reposted, within safe and reasonable limits (whatever the hell those are!)As for beers, I can't say that I have tried them all but I have had a whole slew of the bottled and canned beers tested, with nary a reaction (MAO reaction that is). Phil.
Posted by jsarirose on September 8, 2002, at 19:02:32
In reply to Re: MAO cheese, soy, etc followup, posted by Bobbiedobbs on September 8, 2002, at 18:41:25
> Jessica: The list to which I was referring is from a separate report, "Refining the MAOI DIET: Tyramine Content of Pizzas and Soy Products" by Kenneth I. Shulman M.D and Scott Walker, M.Sc.Pharm (3/1999) and a subsequent report, "A reevaluation of Dietary Restrictions for Irreversible MAOs" by the same guys, dated 06/2001.
Oh, I don't think I saw that one. I haven't had a fear of pizza at all. The only chain I know that uses an unacceptable cheese mix is Godfather's. They have cheddar in the mix. Other than that - I eat pizza as much as I want. (I do make sure I know what cheeses they use on the pizza though.) I also eat parmesan and romano cheeses. I don't over do it, but then it's hard to eat a whole ton of those cheeses anyway. I was wary about parmesan, but since I always ate a little, I recently upped the amount and still had no effect. Then I started reading that it's an okay cheese in moderation. So I guess those items were never really an issue with me.
-Jessica
Posted by cybercafe on September 9, 2002, at 8:08:55
In reply to Re: MAO cheese, soy, etc followup, posted by Bobbiedobbs on September 8, 2002, at 18:41:25
bobbiedobs >> what is covered in "A Reevaluation of Dietary Restrictions for Irreversible Monoamine Oxidase Inhibitors"?
i am actually thinking of dropping by sunnybrook today anyway, their library sells used medical textbooks for like $10 (Shhhhhhhhhhh!!)
Posted by Bobbiedobbs on September 9, 2002, at 13:24:01
In reply to Re: MAO cheese, soy, etc followup, posted by cybercafe on September 9, 2002, at 8:08:55
Not much new if you have seen their previous studies. It summarizes the findings of all of their studies. It provides results of a survey on current attitudes among psychiatrists toward MAOIs and a discussion of the authors' testing methodology and benchmark as to what is considered "safe".
The only thing I hadn't seen was a table listing tyramine content of 11 wines and another table assigning qualitative rankings to the evidence for restrictions of various foods.
Posted by jsarirose on September 10, 2002, at 3:05:32
In reply to Re: MAO cheese, soy, etc followup » cybercafe, posted by Bobbiedobbs on September 9, 2002, at 13:24:01
Swiss Gruyere! And no problem. Yummmm - haven't had flavorful cheese in sooo long. Tomorrow I'm on to the Muenster. I didn't have a ton of the cheese, but I had enough to see if there was a reaction and there wasn't even a trace. I'm not going to worry about that one anymore.
-Jessica
Posted by jsarirose on September 11, 2002, at 1:03:02
In reply to Re: MAO cheese, soy, etc followup, posted by jsarirose on September 10, 2002, at 3:05:32
> Swiss Gruyere! And no problem. Yummmm - haven't had flavorful cheese in sooo long. Tomorrow I'm on to the Muenster. I didn't have a ton of the cheese, but I had enough to see if there was a reaction and there wasn't even a trace. I'm not going to worry about that one anymore.
>
> -JessicaOkay - and Muenster cheese was just fine too. I do take the precaution of cutting off the edges as they sometimes have mold on them. But other than that - no reaction at all. I guess brie (without the rind) will be my next try! (But I need to finish what I bought first.)
-Jessica
Posted by Bobbiedobbs on September 15, 2002, at 14:58:41
In reply to Re: MAO cheese, soy, etc followup, posted by jsarirose on September 11, 2002, at 1:03:02
Jessica - thanks for the trial tests! How large an MAO doseare you taking? I used to be quite a cheese devotee before the MAO era. I plan to try these cheeses (as well possibly as the Kraft mac and cheese) also. Those cheeses are technically considered fresh and soft, although they can have a bit of a bite - so the lack of a prohibition makes sense. It 's great that we have a peer group on the drugs but unfortunate that better info is not available from the doctors and drug company. Phil
> Okay - and Muenster cheese was just fine too. I do take the precaution of cutting off the edges as they sometimes have mold on them. But other than that - no reaction at all. I guess brie (without the rind) will be my next try! (But I need to finish what I bought first.)
>
> -Jessica
Posted by jsarirose on September 15, 2002, at 15:50:46
In reply to Re: MAO cheese, soy, etc followup, posted by Bobbiedobbs on September 15, 2002, at 14:58:41
> Jessica - thanks for the trial tests! How large an MAO doseare you taking? I used to be quite a cheese devotee before the MAO era. I plan to try these cheeses (as well possibly as the Kraft mac and cheese) also. Those cheeses are technically considered fresh and soft, although they can have a bit of a bite - so the lack of a prohibition makes sense.
I'm currently down to 50mg (I was up to 100mg) - that could effect the effect! However I've had no reaction whatsoever and I've eaten a fair amount at a time. The Gruyere was especially exciting for me as I have had a good, sharp, hard cheese in ages. I believe the inside of brie (not the rind) is okay too, but I haven't tried that yet. So, eat with joy! (Hopefully I'm not an anomoly.)
And yes, I wish my doctor was more knowledgable, but I guess she can't know everything in depth. Especially when MAOIs aren't prescribed very often anymore. I try to update her on what I find so she can pass it on to other patients. I've learned much more from the web and user groups than I have from her (about Parnate).
-Jessiac
Posted by cybercafe on September 16, 2002, at 1:02:03
In reply to Re: MAO cheese, soy, etc followup, posted by jsarirose on September 15, 2002, at 15:50:46
bobbiedobs >> i think LostBoyInNC had some macaroni and cheese on a really low dose, like 20 mg, and had a hypertensive crisis
strange eh?
> > Jessica - thanks for the trial tests! How large an MAO doseare you taking? I used to be quite a cheese devotee before the MAO era. I plan to try these cheeses (as well possibly as the Kraft mac and cheese) also. Those cheeses are technically considered fresh and soft, although they can have a bit of a bite - so the lack of a prohibition makes sense.
>
> I'm currently down to 50mg (I was up to 100mg) - that could effect the effect! However I've had no reaction whatsoever and I've eaten a fair amount at a time. The Gruyere was especially exciting for me as I have had a good, sharp, hard cheese in ages. I believe the inside of brie (not the rind) is okay too, but I haven't tried that yet. So, eat with joy! (Hopefully I'm not an anomoly.)
>
> And yes, I wish my doctor was more knowledgable, but I guess she can't know everything in depth. Especially when MAOIs aren't prescribed very often anymore. I try to update her on what I find so she can pass it on to other patients. I've learned much more from the web and user groups than I have from her (about Parnate).
>
> -Jessiac
Posted by jsarirose on September 16, 2002, at 1:23:54
In reply to Re: MAO cheese, soy, etc followup, posted by cybercafe on September 16, 2002, at 1:02:03
> bobbiedobs >> i think LostBoyInNC had some macaroni and cheese on a really low dose, like 20 mg, and had a hypertensive crisis
>
> strange eh?
>My understanding is only something like Kraft Macaroni & Cheese is acceptable. It has to be the processed type cheese (and whatever else they do to it). I wouldn't recommend eating anything remotely related to real cheese in Mac & Cheese. I wonder what brand and style LostBoy tried?
-Jessica
Posted by Bobbiedobbs on September 18, 2002, at 0:04:50
In reply to Re: MAO cheese, soy, etc followup, posted by jsarirose on September 16, 2002, at 1:23:54
Thanks for the warning, cyber. Kraft it is. I guess one advantage of processed food is that it's not completely real so even we can eat it with impunity. I had a TV dinner the other night that listed "water" and "(beef) binders" as it's top two ingredients. Yummy.
Jessica, what is parnate like up in the 60 plus stratosphere. The most I've gotten to is 50 mg. I find it hard to stay asleep and a bit more revved up at the higher levels, although I had experienced that at lower doses also, until I acclamated.
Posted by jsarirose on September 18, 2002, at 0:42:39
In reply to Re: MAO cheese, soy, etc followup, posted by Bobbiedobbs on September 18, 2002, at 0:04:50
> Jessica, what is parnate like up in the 60 plus stratosphere. The most I've gotten to is 50 mg. I find it hard to stay asleep and a bit more revved up at the higher levels, although I had experienced that at lower doses also, until I acclamated.
I'm definitely struggling since I lowered to 40mg. When I was at 100mg I felt pretty great. The best I'd felt in years and years. As I passed 60mg the positive effect just kept increasing. I stopped at 100mg because that was the point at which I could handle the med without being too dizzy. For sleep I take trazodone. I absolutely can't sleep if I don't take anything to help! I would still occasionally cycle in my sleep patterns where I would have trouble sleeping for several days and then crash. But if I regularly took Trazodone it wasn't as bad.
To counteract the dizziness I just split the dose into three times a day. The only problem I would have is if I missed my first dose by more than an hour or so. Then I'd be dizzy and tired for a bit.
The only reason I'm not still at 100mg is because I was trying to taper onto Lamictal and come down in the Parnate. But after I started doing that I started running low on meds and my new insurance only covers 50%. And 50% is still too expensive. So, until I can afford it - I'm at 40mg Parnate, 0 Lamictal. And starting to struggle again depression-wise.
-Jessica
Posted by cybercafe on September 18, 2002, at 13:00:24
In reply to Re: MAO cheese, soy, etc followup, posted by jsarirose on September 18, 2002, at 0:42:39
> I'm definitely struggling since I lowered to 40mg. When I was at 100mg I felt pretty great. The best I'd felt in years and years. As I passed 60mg the positive effect just kept increasing. I stopped at 100mg because that was the point at which I could handle the med without being too dizzy. For sleep I take trazodone. I
Hmm... so at 50 or 60 mg you found you weren't depressed. But if you increase more, not only are you not depressed, but you feel better and better? Hmm.. what does that feel like? :)
So a psychiatrist should/will not consider it a success if we are just free from symptoms of depression, but we should also be feeling pretty good too? because this is how normal people feel?
I never considered that
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