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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by Merci on April 8, 2006, at 13:20:58
I'm having surgery in 10 days and have been off Parnate (60 mg) for several days, per my doctor's request. My depression has returned full force and while I would not call it completely debilitating, as it has been in the past, I cannot fathom how I will possibly get through the next 10 days.
My doctor prescribed Clonazepam to help me in the meantime - I'm sure it's helpful to some people but it's not helping me at all. I am crying all the time, anxious, hopeless and avoiding contact with the outside world as much as possible.
Has anyone else gone through this? I am very open to suggestions, pharmaceutical or otherwise, as to what I can do to get through the next week and a half.
Thank you to anyone who took the time to read this. Be well.
Posted by Jeroen on April 8, 2006, at 14:07:41
In reply to off Parnate for surgery and MISERABLE, posted by Merci on April 8, 2006, at 13:20:58
watch good movies you like, do hobbys when you feel better try go outside for an hour to the shop
Posted by Caedmon on April 8, 2006, at 17:13:19
In reply to Re: off Parnate for surgery and MISERABLE, posted by Jeroen on April 8, 2006, at 14:07:41
I don't know. I know that I respond well to Provigil and Risperdal; it's not perfect, but they lift my mood enough to get through the day, and work immediately. Typically are not contraindicated w/ Parnate or with surgery (well, the Risperdal might be).
I'm going off ADs in order to go ON to Parnate, and I'm miserable. Heh. When I see the doc, I'll still need to washout from Wellbutrin. I'm hoping I can get some Provigil samples to get through the waiting period.
- C
Posted by TylerJ on April 8, 2006, at 17:31:10
In reply to Re: off Parnate for surgery and MISERABLE, posted by Caedmon on April 8, 2006, at 17:13:19
> I don't know. I know that I respond well to Provigil and Risperdal; it's not perfect, but they lift my mood enough to get through the day, and work immediately. Typically are not contraindicated w/ Parnate or with surgery (well, the Risperdal might be).
>
> I'm going off ADs in order to go ON to Parnate, and I'm miserable. Heh. When I see the doc, I'll still need to washout from Wellbutrin. I'm hoping I can get some Provigil samples to get through the waiting period.
>
> - CWaiting periods SUCK! My Pdoc made me wait 5 weeks before starting Parnate, because I was on high dose Prozac and it has a long half life. The only thing I could take was Ativan. Best wishes to you both.
Tyler
Posted by cecilia on April 8, 2006, at 21:17:05
In reply to Re: off Parnate for surgery and MISERABLE » Caedmon, posted by TylerJ on April 8, 2006, at 17:31:10
Merci, see if you can talk to your anesthesiologist. I recently went off Marplan for surgery, the Marplan had no benefit so I was planning to go off it anyway, but later I talked to an anesthesiologist who was surprised that I'd been told me to go off it. She said that the latest thinking was NOT to have patients go off their MAOI's, just for them (the anesthesiologists) to be careful which meds they use during surgery. Obviously, if you were in a major accident they'd HAVE to do surgery whether you were on a MAOI or not, they'd just have to be more careful, so it CAN be done. Since the Marplan was useless it wasn't an issue for me, except that I might have been able to get my surgery done earlier if they hadn't told me to go off. But for a patient who is helped by a MAOI to be told to go off can be dangerous, see if you can find an anesthesiologist with up to date thinking. Cecilia
Posted by gardenergirl on April 8, 2006, at 23:16:43
In reply to Re: off Parnate for surgery and MISERABLE, posted by cecilia on April 8, 2006, at 21:17:05
I don't have specific advice, sorry. But as someone who is also on an MAOI, I empathize. I hope your surgery goes well and the weeks ahead fly by.
Thinking of you...
gg
Posted by JaclinHyde on April 8, 2006, at 23:48:22
In reply to Re: off Parnate for surgery and MISERABLE, posted by cecilia on April 8, 2006, at 21:17:05
You took the words right out of my mouth! I had surgery (major) and was on Marplan at the time (which worked magic for me, btw.) The anesthesiologist said it was ok to stay on it, that there are so many different drugs that they can use to put you out. I came through it with flying colors...and not depressed or miserable cause I stayed on my MAOI. Check with your doc again. Hmmmm....let me do some googling for you.
JH
> Merci, see if you can talk to your anesthesiologist. I recently went off Marplan for surgery, the Marplan had no benefit so I was planning to go off it anyway, but later I talked to an anesthesiologist who was surprised that I'd been told me to go off it. She said that the latest thinking was NOT to have patients go off their MAOI's, just for them (the anesthesiologists) to be careful which meds they use during surgery. Obviously, if you were in a major accident they'd HAVE to do surgery whether you were on a MAOI or not, they'd just have to be more careful, so it CAN be done. Since the Marplan was useless it wasn't an issue for me, except that I might have been able to get my surgery done earlier if they hadn't told me to go off. But for a patient who is helped by a MAOI to be told to go off can be dangerous, see if you can find an anesthesiologist with up to date thinking. Cecilia
Posted by JaclinHyde on April 9, 2006, at 0:23:52
In reply to Re: off Parnate for surgery and MISERABLE, posted by JaclinHyde on April 8, 2006, at 23:48:22
Merci, see the post I put up for you.
JH
Posted by ed_uk on April 9, 2006, at 13:07:20
In reply to off Parnate for surgery and MISERABLE, posted by Merci on April 8, 2006, at 13:20:58
In general, the only reason you need to stop an MAOI before surgery is if your anesthesiologist is not knowledgeable about MAOIs. If your anesthesiologist knows you're on an MAOI and is knowledgeable about MAOIs, there shouldn't be a problem.
Ed
Posted by Caedmon on April 9, 2006, at 16:58:43
In reply to Re: off Parnate for surgery and MISERABLE, posted by Caedmon on April 8, 2006, at 17:13:19
Yeah it's only certain anesthetics that are contraindicated. I think some of them are mainly contraindicated because of hypotensive effects (?). Maybe you should cull together articles and mail them to your anesthesiologist, lol.
- C
Posted by JaclinHyde on April 9, 2006, at 23:03:12
In reply to off Parnate for surgery and MISERABLE, posted by Merci on April 8, 2006, at 13:20:58
Take this and print it out for your doctor to read.
"Do MAOI interact with anesthetic drugs?
MAOI inhibit microsomal enzymes, theoretically potentiating barbituates and opioids.80 Three cases of excessive barbiturate/opioid effects were reported from 1960 to 1970.80,84 Since then, numerous reports have described uneventful anesthetics using barbiturates and various opioids: remifentanil,89 alfen-tanil,89,90 sufentanil,91 fentanyl,80,81 hydromorphone91 and morphine80,81,81,85,89 for patients continuing to take MAOI. Other agents including propofol,90,92 ket-amine,93 midazolam,92 ketorolac,92 vecuronium,92 and atracurium92 have also been used safely. Severe hypertension on induction with etomidate and atracurium has occurred, although the patient’s blood pressure was 200/90 immediately prior to induction.94 Regional anesthesia has been performed without incident when hypotension was treated appropriately with volume and direct-acting sympathomimetics.80,81,95,96 Normal responses to most anesthetic agents can be expected (grade C).Is the continuation of MAOI associated with adverse outcomes?
Much of our understanding of the interactions between MAOI and anesthetic drugs comes from reports of isolated events in individual patients. A controlled prospective evaluation of 27 patients chronically treated with MAOI undergoing 36 anesthetics reported no adverse cardiovascular responses.95 Changes in blood pressure and heart rate were not significantly different from control patients without prior MAOI exposure. Anesthetic agents included sodium thiopental, etomidate, diazepam, succinylcholine, nitrous oxide, volatiles, pancuronium, morphine, spinal tetracaine, epidural bupivacaine, and phenylephrine.95 Similarly a review of a series of 32 orthopedic patients on MAOI who underwent 46 general anesthetics and five regional anesthetics for elective surgery found no adverse hemodynamic events.96 Agents used in this series included sodium thiopental, ketamine, volatiles, morphine and meperidine. Aside from sporadic case reports, the continued use of MAOI/RIMA has not been associated with adverse perioperative events when meperidine and indirect acting catecholamines are avoided (grade B).Conclusion – MAOI
Case reports of sporadic MAOI-related drug interactions prompted many to advise discontinuation of classic MAOI two to three weeks before surgery.80,84,95 Withdrawal of MAOI is not without risks. Many patients have severe depression refractory to other treatment and are at risk for life-threatening psychiatric illness. Acute exacerbation of depression with suicidal ideation has been reported after discontinuation of MAOI prior to elective cardiac surgery.97 There is no literature specifically concerning MAOI and ambulatory anesthesia. MAOI-related drug interactions are possible and have been reported; however, patients continuing to take either classic or selective MAOI remain suitable candidates for ambulatory anesthesia if meperidine, cocaine and indirect-acting catecholamines are avoided."
The link is http://www.cja-jca.org/cgi/content/full/51/8/782#SEC16 near the bottom of the page.
JH
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