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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 linkadge on October 22, 2022, at 17:39:33
I don't think there are any head to head trials comparing the use of these two classes for first episode depression but...
I wonder...
If you took 1000 first time depressed patients and randomly prescribed either parnate or escitalopram, I wonder which med would produce a higher response / remission rate.
MAOIs are currently reserved as a third line treatment, but I just wonder what the repsonse would be if they were given as a first line treatment.
Linkadge
Posted by undopaminergic on October 23, 2022, at 10:01:11
In reply to MAOI vs SSRI, posted by linkadge on October 22, 2022, at 17:39:33
> I don't think there are any head to head trials comparing the use of these two classes for first episode depression but...
>
> I wonder...
>
> If you took 1000 first time depressed patients and randomly prescribed either parnate or escitalopram, I wonder which med would produce a higher response / remission rate.
>
> MAOIs are currently reserved as a third line treatment, but I just wonder what the repsonse would be if they were given as a first line treatment.
>
> LinkadgeI'm inclined to think Parnate would win, but I agree it would be interesting to put it to test. I recall something about TCAs being better for "typical" depression and MAOIs for "atypical", but I'm not sure the effects of TCAs generalise fully to SSRIs.
-undopaminergic
Posted by SLS on October 26, 2022, at 15:43:36
In reply to Re: MAOI vs SSRI, posted by undopaminergic on October 23, 2022, at 10:01:11
In my opinion, Nardil (phenelzine) is the most effective antidepressant available - or at least of those that I know of. Parnate is somewhat inferior to Nardil, especially with respect to treating anhedonia. Nardil is also superior to Parnate when treating anxiety disorders, including panic disorder, social phobia, social anxiety disorder, generalized anxiety disorder, and obsessive-compulsive disorder. Clomipramine might be better for OCD than Nardil, but I haven't come across a head-to-head comparison.
- Scott
Posted by undopaminergic on October 26, 2022, at 16:08:06
In reply to Re: MAOI vs SSRI, posted by SLS on October 26, 2022, at 15:43:36
> In my opinion, Nardil (phenelzine) is the most effective antidepressant available - or at least of those that I know of.
>I thought it was clorgyline. Or do you mean "readily" and/or "clinically" available?
-undopaminergic
Posted by SLS on October 26, 2022, at 19:31:12
In reply to Re: MAOI vs SSRI, posted by undopaminergic on October 26, 2022, at 16:08:06
> > In my opinion, Nardil (phenelzine) is the most effective antidepressant available - or at least of those that I know of.
> >
>
> I thought it was clorgyline. Or do you mean "readily" and/or "clinically" available?
>
> -undopaminergicClorgyline is no longer available for human consumption. It was withdrawn from the NIH in the mid-1990s. It is used now only as a biological probe. As an irreversible MAOI, it is unique in its specificity for MAO-A. Even if clorgyline hadn't been suspected of producing adverse cardiac events, I doubt any pharmaceutical manufacturer would invest to develop a compound for which the patent has long expired.
- Scott
Posted by undopaminergic on October 27, 2022, at 3:04:57
In reply to Re: MAOI vs SSRI » undopaminergic, posted by SLS on October 26, 2022, at 19:31:12
> > > In my opinion, Nardil (phenelzine) is the most effective antidepressant available - or at least of those that I know of.
> > >
> >
> > I thought it was clorgyline. Or do you mean "readily" and/or "clinically" available?
> >
> > -undopaminergic
>
> Clorgyline is no longer available for human consumption.
>Officially. I bought bulk memantine (100 grams) at 98+% purity from a chemical supplier. Clorgyline may be likewise available.
-undopaminergic
Posted by SLS on October 27, 2022, at 10:07:35
In reply to Re: MAOI vs SSRI » SLS, posted by undopaminergic on October 27, 2022, at 3:04:57
> > > > In my opinion, Nardil (phenelzine) is the most effective antidepressant available - or at least of those that I know of.
> > > >
> > >
> > > I thought it was clorgyline. Or do you mean "readily" and/or "clinically" available?
> > >
> > > -undopaminergic
> >
> > Clorgyline is no longer available for human consumption.
> >
>
> Officially. I bought bulk memantine (100 grams) at 98+% purity from a chemical supplier. Clorgyline may be likewise available.
>
> -undopaminergic
>Give it a try. Whatever your source is for clorgyline, I doubt that the product available has been manufactured for human consumption. Clorgyline doesn't exist as an FDA-approved product. If you respond to nothing else, clorgyline meant for rats might make sense. I would certainly entertain the idea of using clorgyline. You have to look for articles addressing long-term usage as well as the possiblity that clorgyline produces adverse cardiac events. How would you know the quality of a specific product?
I would say that if you haven't combined Nardil or Parnate with a secondary tricyclic antidepressant, forget about clorgyline for now. Nadil + nortriptyline is far more effective for me than is clorgyline monotherapy.
- Scott
Posted by undopaminergic on October 27, 2022, at 12:58:18
In reply to Re: MAOI vs SSRI » undopaminergic, posted by SLS on October 27, 2022, at 10:07:35
>
> How would you know the quality of a specific product?
>Ultimately, you would have to get it analysed. I got a CoA (certificate of analysis) from the source along with the product, but an independent analysis would of course be more impartial, and if done competently, more reliable.
-undopaminergic
Posted by SLS on October 27, 2022, at 13:21:46
In reply to Re: MAOI vs SSRI » SLS, posted by undopaminergic on October 27, 2022, at 12:58:18
> >
> > How would you know the quality of a specific product?
> >
>
> Ultimately, you would have to get it analysed. I got a CoA (certificate of analysis) from the source along with the product, but an independent analysis would of course be more impartial, and if done competently, more reliable.
>
> -undopaminergic
>
When will you be trying it?
- Scott
Posted by undopaminergic on October 27, 2022, at 13:30:41
In reply to Re: MAOI vs SSRI » undopaminergic, posted by SLS on October 27, 2022, at 13:21:46
> > >
> > > How would you know the quality of a specific product?
> > >
> >
> > Ultimately, you would have to get it analysed. I got a CoA (certificate of analysis) from the source along with the product, but an independent analysis would of course be more impartial, and if done competently, more reliable.
> >
> > -undopaminergic
> >
>
>
> When will you be trying it?
>The memantine? I already did. It was a great remedy for depression, but it produced a manic condition that led me to impulsively take a massive overdose of it, which ended in intensive care followed by psychiatric hospitalisation. I don't think I would feel safe taking it again without someone to monitor me.
-undopaminergic
Posted by SLS on October 27, 2022, at 14:03:18
In reply to Re: MAOI vs SSRI » SLS, posted by undopaminergic on October 27, 2022, at 13:30:41
> > > >
> > > > How would you know the quality of a specific product?
> > > >
> > >
> > > Ultimately, you would have to get it analysed. I got a CoA (certificate of analysis) from the source along with the product, but an independent analysis would of course be more impartial, and if done competently, more reliable.
> > >
> > > -undopaminergic
> > >
> >
> >
> > When will you be trying it?
> >
>
> The memantine? I already did. It was a great remedy for depression, but it produced a manic condition that led me to impulsively take a massive overdose of it, which ended in intensive care followed by psychiatric hospitalisation. I don't think I would feel safe taking it again without someone to monitor me.
>
> -undopaminergic
>I was asking about clorgyline.
What if you took an anti-manic along with the memantine?
- Scott
Posted by undopaminergic on October 28, 2022, at 7:43:17
In reply to Re: MAOI vs SSRI, posted by SLS on October 27, 2022, at 14:03:18
> > >
> > > When will you be trying it?
> > >
> >
> > The memantine? I already did. It was a great remedy for depression, but it produced a manic condition that led me to impulsively take a massive overdose of it, which ended in intensive care followed by psychiatric hospitalisation. I don't think I would feel safe taking it again without someone to monitor me.
> >
> > -undopaminergic
> >
>
> I was asking about clorgyline.
>Oh, well, that is currently not an alternative. There are other MAOIs to try first, especially tranylcypromine, which I imagine I might also have to acquire from a chemical supplier.
> What if you took an anti-manic along with the memantine?
>That might be worth trying.
-undopaminergic
Posted by SLS on October 28, 2022, at 8:54:14
In reply to Re: MAOI vs SSRI, posted by undopaminergic on October 28, 2022, at 7:43:17
> > > >
> > > > When will you be trying it?
> > > >
> > >
> > > The memantine? I already did. It was a great remedy for depression, but it produced a manic condition that led me to impulsively take a massive overdose of it, which ended in intensive care followed by psychiatric hospitalisation. I don't think I would feel safe taking it again without someone to monitor me.
> > >
> > > -undopaminergic
> > >
> >
> > I was asking about clorgyline.
> >
>
> Oh, well, that is currently not an alternative. There are other MAOIs to try first, especially tranylcypromine, which I imagine I might also have to acquire from a chemical supplier.
>
> > What if you took an anti-manic along with the memantine?
> >
>
> That might be worth trying.
>
> -undopaminergic
If Zyprexa (olanzapine) has had any beneficial effect for depression when added, regardless of the amount of time that it provided benefit, this might be an indicator that adding the right atypical antipsychotic might act as a synergist to memantine in treating your depression and also prevent mania. Since weight-gain is often a side effect of Zyprexa, finding another AP might solve that problem. Saphris (asenapine) and Latuda (lurasidone) come to mind. I don't know enough about Fanapt (iloperidone), but I would search the Internet for information.The other anti-manic strategy is to use anticonvulsants. Trileptal (oxcarbazepine), Depakote (valproate), topiramate (Topamax) are worth looking into. They sometimes demonstrate antidepressant effects when used as an adjunct to antidepressants.
- Scott
Posted by undopaminergic on October 28, 2022, at 11:41:12
In reply to Re: MAOI vs SSRI » undopaminergic, posted by SLS on October 28, 2022, at 8:54:14
> >
> > > What if you took an anti-manic along with the memantine?
> > >
> >
> > That might be worth trying.
> >
> > -undopaminergic
>
>
> If Zyprexa (olanzapine) has had any beneficial effect for depression when added,
>I'm not entirely sure about this, but once olanzapine seemed to help my motivation briefly (as in one dose, possibly two). I've read that serotonin 5-HT2A antagonists can increase dopamine release in the prefrontal cortex, but I also seem to recall that this effect was not sustained with chronic dosing.
> regardless of the amount of time that it provided benefit, this might be an indicator that adding the right atypical antipsychotic might act as a synergist to memantine in treating your depression and also prevent mania. Since weight-gain is often a side effect of Zyprexa, finding another AP might solve that problem. Saphris (asenapine) and Latuda (lurasidone) come to mind. I don't know enough about Fanapt (iloperidone), but I would search the Internet for information.
>Well, I'm on clozapine, trimipramine, and sulpiride, so I don't need more antipsychotics. Alas, I'm not in a position to take memantine at this time.
> The other anti-manic strategy is to use anticonvulsants. Trileptal (oxcarbazepine), Depakote (valproate), topiramate (Topamax) are worth looking into. They sometimes demonstrate antidepressant effects when used as an adjunct to antidepressants.
>That is interesting. I take 200 mg/day of lamotrigine, but I'm inclined to think it has no effect.
-undopaminergic
Posted by SLS on October 28, 2022, at 20:40:38
In reply to Re: MAOI vs SSRI » SLS, posted by undopaminergic on October 28, 2022, at 11:41:12
> > >
> > > > What if you took an anti-manic along with the memantine?
> > > >
> > >
> > > That might be worth trying.
> > >
> > > -undopaminergic
> >
> >
> > If Zyprexa (olanzapine) has had any beneficial effect for depression when added,
> >
>
> I'm not entirely sure about this, but once olanzapine seemed to help my motivation briefly (as in one dose, possibly two). I've read that serotonin 5-HT2A antagonists can increase dopamine release in the prefrontal cortex, but I also seem to recall that this effect was not sustained with chronic dosing.
>
> > regardless of the amount of time that it provided benefit, this might be an indicator that adding the right atypical antipsychotic might act as a synergist to memantine in treating your depression and also prevent mania. Since weight-gain is often a side effect of Zyprexa, finding another AP might solve that problem. Saphris (asenapine) and Latuda (lurasidone) come to mind. I don't know enough about Fanapt (iloperidone), but I would search the Internet for information.
> >
>
> Well, I'm on clozapine, trimipramine, and sulpiride, so I don't need more antipsychotics. Alas, I'm not in a position to take memantine at this time.
>
> > The other anti-manic strategy is to use anticonvulsants. Trileptal (oxcarbazepine), Depakote (valproate), topiramate (Topamax) are worth looking into. They sometimes demonstrate antidepressant effects when used as an adjunct to antidepressants.
> >
>
> That is interesting. I take 200 mg/day of lamotrigine, but I'm inclined to think it has no effect.I completely forgot about lamotrigine. It is a necessary component to my treatment response to depression. However, I don't know about its potential as an anti-manic agent. I don't do well with lamotrigine until I reach 300 mg/day. Most people do well with 200 mg/day, I think. Importantly, I do get a partial improvement at 200 mg/day. Lamotrigine is not an all-or-nothing response.
- Scott
Posted by ed_uk on December 4, 2022, at 13:38:33
In reply to MAOI vs SSRI, posted by linkadge on October 22, 2022, at 17:39:33
Difficult to say. Escitalopram is usually well tolerated, so I'd expect a lot more drop outs in the Parnate group. This could make it difficult to interpret the results. I'm not sure first time patients would be willing to tolerate many side effects.
Posted by SLS on December 4, 2022, at 18:58:20
In reply to Re: MAOI vs SSRI, posted by ed_uk on December 4, 2022, at 13:38:33
> Difficult to say. Escitalopram is usually well tolerated, so I'd expect a lot more drop outs in the Parnate group. This could make it difficult to interpret the results. I'm not sure first time patients would be willing to tolerate many side effects.
I tolerated 150 mg/day just fine. Sure, I had hypotension as a startup side effect, but it disappeared after a couple of weeks. I understand that some people react to Parnate with hypertensive episodes. No drug is right for everybody.
Along with the 150 mg/day of Parnate, I took desipramine 300 mg/day, methylphenidate, supratherapeutic dosages of T4 and Parlodel at some point. I switched from methylphenidate to amphetamine for a trial of about3 weeks. This regime didn't bring me a hell of a lot of improvement, but it was worth a try.
Line up 100 people with atypical depression:
How many will respond to escitalopram?
How many will respond to a MAOI?
Of those people who have taken 3 SRIs and failed to respond, how many would you expect to respond to escitalopram?
Of those people who have taken 3 SRIs and failed to respond, how many would you expect to respond to a MAOI?
Of those drugs you recommended to Linkadge that he takes and plans to continue with, which are the ones capable of bringing him to remission? Take into consideration that Linkadge is not naive to treatment with a huge array of antidepressants and adjuncts.
Time for a change, perhaps?
Taking Effexor for a few days every now and then as a strategy to begin a new career path? A few beads worth?
I can appreciate decades of failed treatment attempts and the torturous nature of the illness, but while working with palliative measures to make life as endurable as possible, why now look for a true remission at the same time.
Palliative measures as my ultimate goal? No chance.
Did I get lucky. Damn right. But I got lucky with:
Nardil
Nortriptyline
Lamotrigine
LithiumEd, which of these four drugs were chosen for their palliative short-term benefits?
Let's get real.
I know my tone is currently challenging and even belligerent, but I am biased by my 40 years of history being treated by and learning from the biggest names in the fledgling practice of psychopharmacology. My remission is the product of being exposed to the developing insights of very innovative minds who had no treatment guidelines to follow. As a cohort, these first psychopharmacologists developed a mentality impelled by a sense of urgency and a dearth of information and understanding. My point is this: In the absence of established information, it takes a great deal of empirical observation and intuition to produce therapeutic success. I learned from this first wave of psychopharmacologists their style of critical thinking fashioned to work as much intuitively as factually. My impression is that these doctors were able to treat mood illness with a rate of success that doesn't seem to me to be much lower than what I see today. It's a matter of approach.
Something is missing today.
- Scott
Posted by SLS on December 5, 2022, at 11:55:25
In reply to MAOI vs SSRI, posted by linkadge on October 22, 2022, at 17:39:33
Hi, Ed.
> I don't think there are any head to head trials comparing the use of these two classes for first episode depression but...
>
> I wonder...
>
> If you took 1000 first time depressed patients and randomly prescribed either parnate or escitalopram, I wonder which med would produce a higher response / remission rate.> MAOIs are currently reserved as a third line treatment, but I just wonder what the repsonse would be if they were given as a first line treatment.
MAOIs easily get more people well than any other single drug. This is the answer given by clinicians without hesitation who actually know how to work with the stuff. I think diet and medication restrictions reflect a higher risk profile than SSRIs. I think that this is the number one reason why doctors don't make MAOIs a first-line treatment. Efficacy is not questioned.
- Scott
This is the end of the thread.
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