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Dr. Bob is Robert Hsiung, MD,
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Posted by Carlos C on June 5, 2004, at 2:43:32
In reply to Re: Starting a new MAOI med for social phobia, posted by RobertPalsing on June 3, 2004, at 21:54:20
If you experiment (slowly, at a level you and your doctor feel comfortable) you'll most likely find that the diet restrictions are over-hyped.
Personally I didn't have to modify my diet at all. I ate aged-cheeses, drank wine, and even took amphetamines while on 90mg of Nardal. None of which raised my blood pressure much. At least not to an alarming rate.
Posted by RobertPalsing on June 5, 2004, at 16:11:07
In reply to Re: Starting a new MAOI med for social phobia » RobertPalsing, posted by Carlos C on June 5, 2004, at 2:43:32
Never taken an MAOI (the only category I haven't touched). With SSRIs I usually noticed a change(if it was going to happen)within 2 weeks, with APs about a week, with TCA around 1-2 weeks. I felt different the first Nardil I took but I still have anxiety. Is there anyone who had massive anxiety that was helped by Nardil that can tell me about their experience in the first few weeks? Just the basics would help. THanks much.
Take care,
"Bob"
Posted by hungry for info on October 11, 2004, at 16:38:29
In reply to Re: Nardil and MAOI diet restrictions » Chairman_MAO, posted by Sad Panda on February 20, 2004, at 7:56:01
I returned from a session with a Psycharist this am. I've been on tri-cyclics & SSRI's since 1980, with on and off relief. In addition to clinial depression, I have primary insomnia as confirmed by a sleep study. Like some of the other posts, I feel I've been popping pills with no real benefit. The Dr. I saw today suggested I consider MAOI's, and said they weren't the dangerous drugs they made out to be. This fellow is an Assoc.Prof. of Psychiatry at Vanderbilt and had good recommendations from his peers, so I tend to feel comfortable with what he says.
Since he suggested I "consider" them, I thought I'd better check them out, and landed here through Google. Boy, the posts don't sound encouraging! I can handle dietary restrictions, but am concerned about dizzyness, fainting, and the other side effects mentioned. How does one function driving, at work, etc. with those kind of side effects. I'm 62 and jobs are tough to come by at my age. I hate to think of jepordizing it by experiencing some of the side effects at work, or not being able to drive.
The SSRI's (& I think I've taken most of them)have made me a zombie also, but still haven't really taken care of the depression. I'm unproductive, getting very clumsy, have no libido (no wise cracks about the age, please!), force myself to do things on weekends; well, really, just not a lot of fun. Outside of the first prescription of tri-cyclics (which seemed to stop working after a year or so), I have had no relief. The insomnia is making everything else worse (or is everything else making the insomnia worse? Good zen question).
Anyway, I'm to the point of trying most anything. But it seems a lot of the side effects discussed are what I'm trying to get away from.
I don't see the Dr. until next month, so have time to ruminate on it. Any inputs would be appreciated.Thanks.
Posted by Tai Chi on October 11, 2004, at 21:26:54
In reply to Re: Nardil and MAOI diet restrictions, posted by hungry for info on October 11, 2004, at 16:38:29
I have struggled with depression for the past 35 years and finally went on Prozac in 1990. However, I soon developed treatment resistance, finding many drugs ( SSRIs, Effexor, Serzone, TCAs, Wellbutrin) either intolerable or ineffective. I did have a successful therapeutic run of four years with Remeron. After the Remeron gave out, I went through 8 months of hell trying different combinations of medications, as well as ECT. A little over a year ago, I started Nardil. Nardil has turned out to be a wonder drug for me, completely alleviating my anxiety and depression. I’m currently taking 45 mg a day.
Posted by bobbiedobbs on October 11, 2004, at 23:40:33
In reply to Re: Nardil and MAOI diet restrictions, posted by Tai Chi on October 11, 2004, at 21:26:54
I've taken several SSRIs besides all three MAOIs. My experience has been that the side effects from the MAOIs are no worse and in some cases more benign than with the SSRIs; generally less fatigue. Dizziness went away after a week or so. Sexual side effects have been dehabiliting on Nardil and Marplan but not on Parnate; however, there are a number of permissable remedies. Finally, many of the diet restrictions are quite (out)dated. You can safely drink all alcohol except draft/microbrew beer, and any of the soft or processed cheeses, including mozarella, processed American slices, ricotta. I would certainly encourage you to try an MAOI based on your experience. The MAOIs have helped me far more than any of the SSRIs.
Phil
Posted by gardenergirl on October 12, 2004, at 20:54:40
In reply to Re: Nardil and MAOI diet restrictions, posted by bobbiedobbs on October 11, 2004, at 23:40:33
Phil,
Can you even drink aged Scotch or other aged liquors? I've really been missing margaritas.gg
Posted by bobbiedobbs on October 13, 2004, at 0:18:49
In reply to Re: Nardil and MAOI diet restrictions » bobbiedobbs, posted by gardenergirl on October 12, 2004, at 20:54:40
Can you even drink aged Scotch or other aged liquors? I've really been missing margaritas.
>
>My immediate answer would be yes. The manufacturer does not include aged liquors (except Sherry and Chianti) in the list of foods to avoid. Nor do any of seven or so recent studies of MAOI diets published within the past several years, of which I have copies. (There's a lot of controvery, by the way, about whether Sherry and Chianti even need to be restricted.) The only type of alcohol that shows up on the "to be avoided" list in any of these studies are draft/tap beers, and other beer or wine above certain daily quantities (the conservative consensus is an allowance of no more than four ounces of wine per day (no restriction on red) and no more than 2 bottled or canned beers per day; however, these are way conservative in that the studies show you'd pass out before consuming a tyramine level significant enough to have any effect.
A couple of suggestions: post the question about aged liquors on the Yahoo group on MAOIs (Go to Yahoo groups, then search.) You might also wish to contact Kenneth Shulman at the Dept. of Psychiatry, Sunnybrook Health Science Center, 2075 Bayview Ave, Toronto Canada M4N 3M5.
He probably has studied this issue more than anyone and responds to written requests.
Skoal. Phil
>> gg
Posted by Sad Panda on October 13, 2004, at 22:14:14
In reply to Re: Nardil and MAOI diet restrictions, posted by hungry for info on October 11, 2004, at 16:38:29
> I returned from a session with a Psycharist this am. I've been on tri-cyclics & SSRI's since 1980, with on and off relief. In addition to clinial depression, I have primary insomnia as confirmed by a sleep study. Like some of the other posts, I feel I've been popping pills with no real benefit. The Dr. I saw today suggested I consider MAOI's, and said they weren't the dangerous drugs they made out to be. This fellow is an Assoc.Prof. of Psychiatry at Vanderbilt and had good recommendations from his peers, so I tend to feel comfortable with what he says.
>
> Since he suggested I "consider" them, I thought I'd better check them out, and landed here through Google. Boy, the posts don't sound encouraging! I can handle dietary restrictions, but am concerned about dizzyness, fainting, and the other side effects mentioned. How does one function driving, at work, etc. with those kind of side effects. I'm 62 and jobs are tough to come by at my age. I hate to think of jepordizing it by experiencing some of the side effects at work, or not being able to drive.
>
> The SSRI's (& I think I've taken most of them)have made me a zombie also, but still haven't really taken care of the depression. I'm unproductive, getting very clumsy, have no libido (no wise cracks about the age, please!), force myself to do things on weekends; well, really, just not a lot of fun. Outside of the first prescription of tri-cyclics (which seemed to stop working after a year or so), I have had no relief. The insomnia is making everything else worse (or is everything else making the insomnia worse? Good zen question).
>
> Anyway, I'm to the point of trying most anything. But it seems a lot of the side effects discussed are what I'm trying to get away from.
> I don't see the Dr. until next month, so have time to ruminate on it. Any inputs would be appreciated.
>
> Thanks.
>
>Which TCA's have you tried? Some of them are pretty good for insomnia. A frequent problem with MAOI's is insomnia.
Cheers,
Paul.
Posted by gardenergirl on October 13, 2004, at 23:20:18
In reply to Re: Nardil and MAOI diet restrictions » gardenergirl, posted by bobbiedobbs on October 13, 2004, at 0:18:49
Thanks!
gg
Posted by jparsell82` on October 14, 2004, at 13:47:29
In reply to Re: Nardil and MAOI diet restrictions, posted by Sad Panda on October 13, 2004, at 22:14:14
I'm on day 8 of Nardil 45mg and I'm thinking of bumping it up to 60mg because I'm really not experience any side effects. I sleep a little longer and my appetite's a bit increased but nothing much. I also haven't had any problems with what I've consumed so far.... alcohol, parmesan, mozzarella cheese, etc. The one I really miss though is cheddar cheese. The other night we had tacos and I didn't know what I should do cheese-wise. I ended up just sprinkling a little bit of cheddar cheese and had no problem. Is there any kind of cheddar cheese that's safe? Oh, and is pepperoni ok? Because I've been eating it too without problems so far. Thanks,
Josh
Posted by King Vultan on October 14, 2004, at 14:49:57
In reply to Cheddar Cheese?, posted by jparsell82` on October 14, 2004, at 13:47:29
If you eat enough cheddar cheese, you will suffer a hypertensive crisis, but the amount required varies from person to person, and Nardil is not as bad as Parnate. Generally, the more aged the cheese, the worse it is, but even medium cheddar contains a substantial amount of tyramine. I believe your risk also goes up with increasing MAOI dosage, as you will have more MAO-A inhibition at the higher dosages. I do not have the exact figures in front of me, but even one slice of cheddar cheese can induce a BP change in someone on 20 mg Parnate. For someone on 60 mg Nardil, it takes about 4 times as much tyramine to raise a person's BP 30 mm HG as it does on 20 mg Parnate, based on a tyramine pressor study in "Clinical Advances in Monoamine Oxidase Inhibitor Therapies".
I am on 50 mg Parnate and was on a high dose of Nardil for some months before that and have so far avoided anything with any amount whatsoever of cheddar cheese in it. I may be overcautious, but cheese is by far the food most associated with inducing hypertensive crises in case reports. I suppose what I could do is pick a food that I have been avoiding that contains cheddar cheese, such as Cheetos, check my BP, eat a small number of them, and then monitor my BP afterwards to see if it goes up. If not, then the next day, I could try doubling the amount, and see if that makes a difference, and the next day, double it again. This may sound ridiculous, but this methodology is similar to what is actually used in tyramine pressor tests on volunteer patients, except that they would probably use tyramine capsules with a known amount of tyramine in them.
As for pepperoni, I do eat pepperoni on pizza, but only certain brands that I have a high confidence level in, and you need to make sure that the cheese used is mozzarella or another low tyramine variety. I have read two anecdotes from different people who suffered hypertensive crises while on Parnate from eating pepperoni pizza at small, local pizza shops, but I do not know if it was the pepperoni that got them, or if it was the cheese.
Todd
Posted by bobbiedobbs on October 14, 2004, at 21:23:09
In reply to Re: Cheddar Cheese? » jparsell82`, posted by King Vultan on October 14, 2004, at 14:49:57
Re Pepperoni - it is on all of the no-no lists. However, a 1999 study by the Dept. of Psychiatry at Sunnybrook Health Science Center in Toronto found no significant tyramine levels in double pepperoni/double cheese pizzas from large Pizza Hut, McDonalds, Pizza Pizza and Dominos. "Conclusion: pizzas from larger commercial outlets are safe for coneumption with MAOIs." FYI, I've eaten pepperoni in fairly large quantities for many years while taking MAOIs without adverse consequence. Cheddar cheese is a whole nother story. You might try Velveeta, Cheeze Whitz or Kraft Mac and Cheese, cheap but safe cheddar substitutes.
Posted by mack2099 on April 13, 2005, at 8:48:38
In reply to Re: Nardil and loss of appetite and diarrhea, posted by cosis on April 20, 2003, at 1:06:52
I have been taking Nardil off and on (mostly on) for 18 years! I have been taking it regularly for the last 6 years. I have found on several occasions during the last 18 years that when I exercise regularly (at least 30 mins. daily of aerobic exercise) that my appetite is greatly supressed and losing weight is very easy. However, during the last 2 years I have gained @ 80 lbs. and have felt very tired--getting very little exercise as I just didn't feel up to it. We moved out of state and before I could get an appt. with a new dr. I saw that my current supply of Nardil would run out, so I began tapering off from 60 mg. daily down to 45, 30, 15 and completely off after tapering off for @ 4 wks. Several days after I was completely off my appetite changed suddenly from ravenous (expecially for sweets and alcoholic beverages--especially wine) to normal. I began to lose weight and actually feel better and not as tired. My whole attitude has improved tremendously. Has anyone else experienced symptoms similar to these??? I'm thinking now that I don't want to return to Nardil--especially not for a while.
> > Hello
> > I took Nardil for 4 weeks and suffered loss of appretite, diarhea and lost 10 lbs. I was stopped by the police for driving while impaired. Has anybody else had any similar experiences. My doctor has vaguely suggested a hypoglycemic attack. He says the usual side effect is constipation not diarrhea but the diarrhea stopped when I stopped the Nardil and I are ravenously for several days after, so there does seem to be a correlation. Any help would be appreciated.
> > Mairwen
>
> Most of the people have a weight gain instead of loss... My appetite definately changed more towards sweet tasting foods which is responsible for about 10 lbs of weight gained...
>
> I am not sure I understand your police issue.. You were impaired from Nardil? When I drive sometimes I almost fall asleep.. It is kind of dangerous so I usually get out and move around then I am usually fine.. Or smack myself in the face a few times :)
>
>
Posted by ed_uk on April 13, 2005, at 9:45:11
In reply to Re: Nardil and loss of appetite and diarrhea, posted by mack2099 on April 13, 2005, at 8:48:38
Hi,
>I'm thinking now that I don't want to return to Nardil--especially not for a while.
Do you think you would try Parnate if you need an antidepressant in future? It's claimed to cause less weight gain than Nardil.
Regards,
Ed.
Posted by bill.e on April 23, 2005, at 9:04:55
In reply to Re: Nardil and loss of appetite and diarrhea, posted by cosis on April 20, 2003, at 1:06:52
> > Hello
> > I took Nardil for 4 weeks and suffered loss of appretite, diarhea and lost 10 lbs. I was stopped by the police for driving while impaired. Has anybody else had any similar experiences. My doctor has vaguely suggested a hypoglycemic attack. He says the usual side effect is constipation not diarrhea but the diarrhea stopped when I stopped the Nardil and I are ravenously for several days after, so there does seem to be a correlation. Any help would be appreciated.
>I've been taking nardil for 15 years so maybe I can help. I take the pills throughout the day, not more than one at a time. More than one 15mg pill at a time will give me some diarrhea the next day. Eating something around pill time can help alot. Increasing the dose gives me some diarrhea or constipation and some cycling between the two until I adjust to it.
When I first started nardil I lost 15 lbs but all these years later I've put it all back and then some... age catching up with me.
Too high a dose can bring symptoms of hypermania - could be the reason for your driving incident.
Posted by Rich340 on May 14, 2005, at 6:15:30
In reply to Re: hypertensive experiences? , posted by fritz on October 21, 2003, at 22:31:50
Last week I needed to unblock my nasal passages following radical radiation therapy to irradicate cancer from the lower half of my nose. Bought some Nyal nose spray in desparation. 2 squirts in each nostril.
90 minutes later , I had to pull over to the side of the road with a monstrous migraine, wet all over with sweats, needing to find a toilet, very fast.For me, it was a matter of trying to survive. I was taken to hospital by ambulance with, amongst other things, elevated blood pressure and a neckache like I 've never had before.
I have been on MAOIs for 25 years. First time crisis. Problem now is that I have persisting headaches and neckache with some continuing elavated B.P. some 6 days later and have been unable to work in the interim.
Hell of a price to pay for the only antidpressant that really works for me!
Posted by gardenergirl on May 14, 2005, at 15:19:19
In reply to Re: hypertensive experiences?, posted by Rich340 on May 14, 2005, at 6:15:30
Sounds like an awful experience. Did the nasal spray have psuedoephedrine in it?
gg
Posted by KaraS on May 14, 2005, at 16:09:59
In reply to Re: hypertensive experiences?, posted by Rich340 on May 14, 2005, at 6:15:30
> Last week I needed to unblock my nasal passages following radical radiation therapy to irradicate cancer from the lower half of my nose. Bought some Nyal nose spray in desparation. 2 squirts in each nostril.
>
> 90 minutes later , I had to pull over to the side of the road with a monstrous migraine, wet all over with sweats, needing to find a toilet, very fast.For me, it was a matter of trying to survive. I was taken to hospital by ambulance with, amongst other things, elevated blood pressure and a neckache like I 've never had before.
>
> I have been on MAOIs for 25 years. First time crisis. Problem now is that I have persisting headaches and neckache with some continuing elavated B.P. some 6 days later and have been unable to work in the interim.
>
> Hell of a price to pay for the only antidpressant that really works for me!
>
>
That sounds so horrible! The nose spray must have had pseudophedrine in it as gg suggested. It sounds like you've been very careful if you've never had a crisis in 25 years. Nyal is an Australian brand, isn't it? Do they list the ingredients on the package there or not?I'm so sorry you're still not feeling well. I've heard of the after-effects lasting a couple of days but not 6. Did they give you anything to help you keep the blood pressure down or anything to take for the continuing pain?
If you are in Australia I'm curious as to how you managed to get an MAOI prescribed. Do you mind if I ask you which one are you taking? I have a friend who lives in Australia who desperately wants to try Parnate but has not been able to get it prescribed. Maybe because you started on it so many years ago...
Sorry for all of the questions. I hope you feel better soon. It is definitely too high a price to have to pay for feeling normal but hopefully you'll never have another one ever again. I hope your nose is better soon too.Take care,
Kara
Posted by Declan on May 14, 2005, at 20:52:41
In reply to Re: hypertensive experiences? » Rich340, posted by KaraS on May 14, 2005, at 16:09:59
If I remember correctly Nyal contains phenylephrine, rather than, as many others do, oxymetazoline. And perhaps phenylephrine is fairly close to adrenaline. I'm interested because I'm thinking about a MAOI but take pseudoephedrine for an allergic thingo (high IgE). My sinuses get blocked. I take chinese herbs for it mainly, and they may be a problem with a MAOI too.
Declan
Posted by Rich340 on May 14, 2005, at 22:06:48
In reply to Re: hypertensive experiences? » Rich340, posted by KaraS on May 14, 2005, at 16:09:59
Posted by Rich340 on May 14, 2005, at 22:41:20
In reply to Re: hypertensive experiences? (nm) » KaraS, posted by Rich340 on May 14, 2005, at 22:06:48
Typed lengthy followup. Must have screwed up on submit process.
Can I retrieve the text or must I (uggh!)start again?
Help!
Posted by KaraS on May 15, 2005, at 2:14:50
In reply to Re: hypertensive experiences? » Rich340, posted by Rich340 on May 14, 2005, at 22:41:20
> Typed lengthy followup. Must have screwed up on submit process.
>
> Can I retrieve the text or must I (uggh!)start again?
>
> Help!
Bummer! I think you checked the box that says "no message" (because you have the "nm" in your message title) so the program erased all that you had typed. I appreciate the effort anyway.K
Posted by Dr. Bob on May 15, 2005, at 2:15:07
In reply to Re: hypertensive experiences? » Rich340, posted by Rich340 on May 14, 2005, at 22:41:20
> Typed lengthy followup. Must have screwed up on submit process.
>
> Can I retrieve the text or must I (uggh!)start again?
>
> Help!Sorry, but at this point you probably have to start again. Sometimes you can go “back” and your text will be there. Sometimes a new window will open with your text. Sometimes people compose in Word or something and cut-and-paste to post. Better luck next time,
Bob
Posted by Rich340 on May 15, 2005, at 6:55:20
In reply to Re: hypertensive experiences? » Rich340, posted by Rich340 on May 14, 2005, at 22:41:20
Its never as good the second time 'round, however here goes.
Regarding your request re the MAOI which I take, it is Nardil.
It is part of a cocktail of drugs for minimising the impact of Bipolar disorder 2 which has adversley impacted my professional career as a practicing international lawyer over the last 33 years.
Availability of the drug itself is no problem in Australia: rather, it is the avaiability of Psychiatrists who will prescribe it that is the problem.
My original psychopharmacologist insisted I try Nardil for some years. The list of unacceptable foods contained many of my favourites! In the end, my absences from work dictated I had no option. He compared Nardil and the other MAOI avilable in Australia, Parnate, to a tried and true 'cannon' as opposed to the slick 'rifle shot' weapons that the later generations of anti depressants comprise.
Regarding the cocktail, just in case this may help someone- not necesarily the specifics, but the rewards for having gotten there: I have titrated the drugs comprising the cocktail, with the blessing of my current psych., to the point where I have reduced the Lithium and introduced carbamazepine. My present cocktail comprises the following:
Morning-4 Nardils + 1/2 Carbamazepine(400mgCR)+1 20 mg Propanalol.
Lunch- 2 nardils + 1 20mg Propanalol.
Bedtime- 1 Carbamazepine (400mgCR) + 1 Lithium (250).Now hear this! I have for almost all of my life suffered a depressive episode 1 week in every four. Since I began the present regime, I have now completed 26 weeks in a row (or 6 months or half a year!) without a significant depressive episode (not more than one day of questionable mood).
This has inevitably resulted in some cockiness on my part causing me to 'push the envelope' with foods,drinks, etc, ever so carefully. I thought I had the 'beast' under control. Hence the H.T.C. and my time in Hospital. Thankfully, no resultant depression , at all!
My G.P. suggested Adalat (Nifedipine/ Procardia to you?) 3 x daily yesterday. Headaches have gone. Blood pressure has returned to normal, for me.One unforgettable lesson.
Really value this support group in cyberspace.
Hope some of this helps someone else, somehow.
R.
Posted by awatts on May 15, 2005, at 12:01:26
In reply to Re: screwed up on submit process, posted by Dr. Bob on May 15, 2005, at 2:15:07
> Sorry, but at this point you probably have to start again. Sometimes you can go “back” and your text will be there. Sometimes a new window will open with your text. Sometimes people compose in Word or something and cut-and-paste to post. Better luck next time,
>
> BobDr. Bob,
I have tried to compose in Word and then cut and paste to babble. I lost all of the Word formatting. What's the proper was to do this and retain the Word formatting?
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