![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 18 of 18. This is the beginning of the thread.
Posted by rose45 on May 14, 2020, at 6:45:30
HAS ANYONE ELSE LIKE ME HAD THE MISFORTUNE TO HAVE BOTH MAOIS STOP WORKING, BUT FOUND THAT THEY DID START WORKING AGAIN SOME YEARS LATER? Nardil stopped working 7 years ago and parnate stopped working 1 year ago when I slightly reduced the dose of 30mg. It will not work again, even at a higher dose. I am very ill and desperate and hardly able to function, and wondering whether to risk coming off the parnate and trying nardil again if I can get hold of enough here in the UK. The MAOIS are the only meds that have ever worked for me. I hear that it is hard coming off parnate. I am in the uk. Has anyone had any of the above experiences? I just cannot remain as I am and dont know what to do.
Posted by undopaminergic on May 14, 2020, at 9:19:58
In reply to maoi poop out., posted by rose45 on May 14, 2020, at 6:45:30
> HAS ANYONE ELSE LIKE ME HAD THE MISFORTUNE TO HAVE BOTH MAOIS STOP WORKING, BUT FOUND THAT THEY DID START WORKING AGAIN SOME YEARS LATER? Nardil stopped working 7 years ago and parnate stopped working 1 year ago when I slightly reduced the dose of 30mg. It will not work again, even at a higher dose. I am very ill and desperate and hardly able to function, and wondering whether to risk coming off the parnate and trying nardil again if I can get hold of enough here in the UK. The MAOIS are the only meds that have ever worked for me. I hear that it is hard coming off parnate. I am in the uk. Has anyone had any of the above experiences? I just cannot remain as I am and dont know what to do.
>I'm sorry there is not much I can do to help. Maybe experiment with combinations. Eg. trimipramine and nortriptyline can be combined with MAOIs. So can antipsychotics, such as aripiprazole and cariprazine. Stimulants work too, even though you have to start carefully with the amphetamines. There are other options, but these are what I would consider first.
-undopaminergic
Posted by rose45 on May 16, 2020, at 7:52:40
In reply to Re: maoi poop out., posted by undopaminergic on May 14, 2020, at 9:19:58
thank you..... antipsychotics dont do anything for me. only the maois have ever worked.
Posted by undopaminergic on May 16, 2020, at 8:17:36
In reply to Re: maoi poop out., posted by rose45 on May 16, 2020, at 7:52:40
> thank you..... antipsychotics dont do anything for me. only the maois have ever worked.
>I meant in combination with the MAOI. Someone here reported that the MAOI started working again after she added an antipsychotic (AP). I think the important action of APs in depression is their blockade of serotonin 5-HT2 receptors. With that in mind, you could also try mirtazapine or even cyproheptadine (an anti-histamine).
Have you tried any serotonin 5-HT1A receptor agonists? Eg. buspirone and vortioxetine.
-undopaminergic
Posted by SLS on May 16, 2020, at 19:41:28
In reply to Re: maoi poop out., posted by undopaminergic on May 16, 2020, at 8:17:36
Hi, Rose.
What happened to you is cruel. I've heard of that happening frequently with Nardil, but not so much with Parnate. The term "drug-induced drug refractoriness" is sometimes used to described the phenomenon. RM Post first suggested it with the use of lithium in the 1990s.
In my experience, the dosage range for Parnate is 40-80 mg/day. For me, 80 mg/day is about right. Some people don't respond consistently to Parnate until they reach 120 mg/day. You won't find many doctors willing to use Parnate that way.
> I meant in combination with the MAOI. Someone here reported that the MAOI started working again after she added an antipsychotic (AP). I think the important action of APs in depression is their blockade of serotonin 5-HT2 receptors. With that in mind, you could also try mirtazapine or even cyproheptadine (an anti-histamine).
>
> Have you tried any serotonin 5-HT1A receptor agonists? Eg. buspirone and vortioxetine.
>
> -undopaminergic
Hi, UD.Have you known anyone to combine a MAOI with mirtazapine? I've never seen it suggested. Is there any risk of a hypertensive reaction?
I have always needed to combine a MAOI with a tricyclic in order to see an improvement. I like nortriptyline better than desipramine. For me, nortriptyline has a distinct "mood brightening" effect that desipramine lacks. My only stable remission lasted for 9 months. I was taking Parnate + desipramine. My doctor decided that I should discontinue treatment because of the emergence of mania (bordering on psychosis). I relapsed 2 months later, and that combination never brought me to remission again.
- Scott
Posted by rose45 on May 17, 2020, at 5:10:57
In reply to Re: maoi poop out., posted by undopaminergic on May 16, 2020, at 8:17:36
yes that person was me. I was taking a low dose of olanzapine, and suddenly the parnate worked again. This has happened to someone else also. Stupidly, under guidance from Gillman, i reduced the olanzapine very very slowly, and after 5 months the parnate stopped working altogether. In hindsight, it was stupid of me to lower the olanzapine, but I hear that it is a dangerous drug. I tried going back on the olanzapine after that, but it never worked again.
Posted by rose45 on May 17, 2020, at 5:29:41
In reply to Re: maoi poop out., posted by SLS on May 16, 2020, at 19:41:28
Do you think its worth coming off the parnate and trying it again? I hear that it can be very painful coming off it. I read somewhere SLS, that that was your experience. The parnate only stopped after I reduced it. I always did well on it at 30 mg and really liked it and was doing well on it. But now Im losing my mind...... it obviously covered up my strong anxiety which is now taking over. Im in the UK, and we dont have that many choices of drugs here.
Posted by undopaminergic on May 17, 2020, at 7:50:47
In reply to Re: maoi poop out., posted by SLS on May 16, 2020, at 19:41:28
>
> Hi, UD.Hi SLS!
> Have you known anyone to combine a MAOI with mirtazapine? I've never seen it suggested. Is there any risk of a hypertensive reaction?
>Now that you mention it, yes, I overlooked that. Even in the absense of a MAOI, mirtazapine increases pulse and blood pressure. Surely they can be combined, but you better proceed with caution.
> I have always needed to combine a MAOI with a tricyclic in order to see an improvement. I like nortriptyline better than desipramine. For me, nortriptyline has a distinct "mood brightening" effect that desipramine lacks. My only stable remission lasted for 9 months. I was taking Parnate + desipramine. My doctor decided that I should discontinue treatment because of the emergence of mania (bordering on psychosis). I relapsed 2 months later, and that combination never brought me to remission again.
>Of the TCAs, I've only tried trimipramine.
-undopaminergic
Posted by undopaminergic on May 17, 2020, at 8:54:44
In reply to Re: maoi poop out. » undopaminergic, posted by rose45 on May 17, 2020, at 5:10:57
> In hindsight, it was stupid of me to lower the olanzapine, but I hear that it is a dangerous drug.
>It can be. There is a risk of weight gain and diabetes, and less often, it can produce a movement disorder called tardive dyskinesia, which can be permanent.
Still, doctors prescribe these drugs, antipsychotics, like candy.
-undopaminergic
Posted by undopaminergic on May 17, 2020, at 8:56:58
In reply to Re: maoi poop out., posted by rose45 on May 17, 2020, at 5:29:41
> Im in the UK, and we dont have that many choices of drugs here.
Well, at least you have Parnate, which is not available here in north Europe.
-undopaminergic
Posted by rose45 on May 18, 2020, at 5:29:30
In reply to Re: maoi poop out. » rose45, posted by undopaminergic on May 17, 2020, at 8:56:58
im desperate. In a very bad state - no memory, and anxiety so bad that im unable to go out unaccompanied...The uk nhs have put me on lamotrigine... and im not bipolar, and dont want to get addicted to it. . I just dont know what to do. Is there a chance of parnate working again (they still havent taken me off it) I could go off it and try parnate or nardil again, but suspect nardil would not be as powerful after having been on parnate, which is stronger and did work well for me. I am very scared.My baseline was very fearful and full of anxiety and it seems that parnate covered it up well, but now its not working, the anxiety has become even more unbearable.
Posted by undopaminergic on May 18, 2020, at 6:57:10
In reply to Re: maoi poop out., posted by rose45 on May 18, 2020, at 5:29:30
> im desperate. In a very bad state - no memory, and anxiety so bad that im unable to go out unaccompanied...The uk nhs have put me on lamotrigine... and im not bipolar, and dont want to get addicted to it. . I just dont know what to do. Is there a chance of parnate working again (they still havent taken me off it) I could go off it and try parnate or nardil again, but suspect nardil would not be as powerful after having been on parnate, which is stronger and did work well for me. I am very scared.My baseline was very fearful and full of anxiety and it seems that parnate covered it up well, but now its not working, the anxiety has become even more unbearable.
>Lamotrigine is not necessarily a bad choice. You could try adding lithium too, it can sometimes boost the response to antidepressants.
As for anxiety, my approach is to deliberately focus on the anxiety, trying to feel it a fully as you can, and if you do this, the anxiety goes away faster than if you try to suppress it.
-undopaminergic
Posted by Jadde on May 18, 2020, at 10:29:44
In reply to maoi poop out., posted by rose45 on May 14, 2020, at 6:45:30
> HAS ANYONE ELSE LIKE ME HAD THE MISFORTUNE TO HAVE BOTH MAOIS STOP WORKING, BUT FOUND THAT THEY DID START WORKING AGAIN SOME YEARS LATER? Nardil stopped working 7 years ago and parnate stopped working 1 year ago when I slightly reduced the dose of 30mg. It will not work again, even at a higher dose. I am very ill and desperate and hardly able to function, and wondering whether to risk coming off the parnate and trying nardil again if I can get hold of enough here in the UK. The MAOIS are the only meds that have ever worked for me. I hear that it is hard coming off parnate. I am in the uk. Has anyone had any of the above experiences? I just cannot remain as I am and dont know what to do.
Sorry youre going thru that. Nardil was amazing for me, now, not so much. Its very frustrating. I had to discontinue for a medical procedure, then upon reinstating, lost the a/d effect. Its scary, but Im trying again. This time I had that first good week so Im hopeful. Maybe you could give Nardil another shot? Im considering adding something but I have no idea what. My psychiatrist isnt very creative. Good luck to you...Jade
Posted by rose45 on May 18, 2020, at 10:35:18
In reply to Re: maoi poop out., posted by Jadde on May 18, 2020, at 10:29:44
how much time did you leave behind each attempt to start. ?
Im wondering if I come off the parnate and start again whether it would work.
Posted by Jadde on May 18, 2020, at 10:48:55
In reply to Re: maoi poop out., posted by rose45 on May 18, 2020, at 10:35:18
> how much time did you leave behind each attempt to start. ?
> Im wondering if I come off the parnate and start again whether it would work.The first time I was off for maybe 6 weeks. Was a fairly easy withdrawal. When I found it no longer worked after 12 weeks back on, I decided to withdraw again. This time was absolute hell. So I got down to 15mg per day and had to reinstate it. Curiously, I got that mild euphoria in the first week back on 60mg. But like you, Im afraid.
I, too, did a trial with Parnate which ended badly. It was also a miracle at first, after adding Dexedrine. I dont recommend that combination.
Jade
Posted by rose45 on May 18, 2020, at 14:08:29
In reply to Re: maoi poop out. » rose45, posted by Jadde on May 18, 2020, at 10:48:55
Did you take anything with the nardil to make coming off it easier ? If Im to come off the parnate, I know it will be very painful.Psychiatrists suggest taking anti-psychotics, but I cant see how they can really help like a benzo.
Posted by Jadde on May 18, 2020, at 16:14:17
In reply to Re: maoi poop out., posted by rose45 on May 18, 2020, at 14:08:29
> Did you take anything with the nardil to make coming off it easier ? If Im to come off the parnate, I know it will be very painful.Psychiatrists suggest taking anti-psychotics, but I cant see how they can really help like a benzo.
I was already taking 5mg Olanzapine for sleep. And no, it didnt help. I think my mistake was coming off of Nardil too fast. I would highly recommend going very slowly. Years ago, I was abruptly taken off Parnate, and given Geodon. It cured my psychosis, but I was left with debilitating anxiety.
If I had it to do over, I would ask for a short term benzo (something like lorazapam) and take my time withdrawing.
Hope that helps,
Jade
Posted by linkadge on May 18, 2020, at 17:32:30
In reply to Re: maoi poop out., posted by rose45 on May 18, 2020, at 14:08:29
You could try a night of total sleep deprivation (this can, for some people, help antidepressants work better). I know that MAOIs have been combined with tryptophan and/or lithium. Adding some folic acid may help too.
Linkadge
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.