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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by temoigneur on November 28, 2002, at 16:27:41
I was wondering if you might be able to give me advice on parnate as to wehtehr or not it would help me to get off the heavy medication regime I'm on. I've never tried a MAOI before. I've had a ten year history of very mild Tourrettes, severe OCD, generalized anxiety, panic attacks, and social phobia. Currently I'm on a heavy regiment of medications; zyprexa prozac, effexor, klonopin, trazadone, and modafinil. My neuropsychiatrist encourages me to drink coffee with the modafinil to offset the sedating effects of the medications. I try to remain hopeful, as there was a four month period, when I first started SSRI's, (prozac) that I felt wonderful, I was able to take a full load in college, (I had previously struggled to hold down a half load), and get almost a 4.0 average. Underneath it all I have potential, but the years are passing, I'm twenty four now, and in my present condition, I'm unable to function academically or socially at any meaningful level. I've been through an intensive behavioral program, and put everything I had into it, they had to tell me to slow down at some points, yet I returned home to Canada, on less medication, and more neurotic than when I left. At one point I purposefully burnt myself with an iron as a sort of punishment to ward of suicidal thoughts. Any suggestions you could give would be so much appreciated, I live in Vancouver Canada. With this history, does anyone think parnate might be worth a try? Thanks
Ben
Posted by ShelliR on November 28, 2002, at 17:29:45
In reply to never tried MAOI's on heavy regiment now, sug.??, posted by temoigneur on November 28, 2002, at 16:27:41
Hi Ben,
I'm glad that you are still feeling hopeful.
My recollection is that it is another MAOI, nardil, which is the most successful with social phobia and generalized anxiety. Is there a reason why your psychiatrist is suggesting parnate over nardil?I was on nardil for many years and it was very successful for me. In the past few years it lost its effectiveness; still, my success on it had lasted over twenty years. Actually I started when I was about your age. I also augmented with either valium or klonopin: valium worked better for me with panic attacks, but had a bad name as an "addictive" drug, although according to my pdoc, the difference is minimal. Klonopin was also fine, just took a long time to "hit" and I think it is a better drug to take on a regular basis than as a prn.
I have never been successful with the SSRIs; when nardil pooped out, I tried parnate, but it made me way too sleepy. When I added lamictal to nardil, it again worked very well. Unfortunately I gained fifteen pounds of water weight and went off the lamictal. When I tried the combination again, it didn't give me the same success. I was so depressed by that time, I would have gladly accepted those fifteen pounds back in exchange for losing the depression.
Since you were successful at first with prozac, I wonder if it's worth trying another SSRI, maybe lexapro, before making the decision to go through the long waiting period to rid your body of effexor and prozac before trying parnate or nardil. Or have you tried other SSRIs, also unsuccessfully?
I'm sorry that you're having such a hard time, and I think it's good that you are thinking about MAOIs as a possibility; I think they are way under-used and can be a miracle drug for many of us with difficult to treat depression.
Shelli
Posted by BrittPark on November 28, 2002, at 17:33:55
In reply to never tried MAOI's on heavy regiment now, sug.??, posted by temoigneur on November 28, 2002, at 16:27:41
The trouble with MAOIs is that you would have to stop taking many of your medications before you can safely start taking the MAOI. Have you considered a tricyclic? You could add it in slowly and taper off the prozac (prozac raises blood levels of tricyclics drastically), and then if it works for you, you could start tapering some of the other medications. Just one (of many) possibility.
Hang in there and you'll find the right combination.
Feel Better,
Britt
Posted by ShelliR on November 28, 2002, at 18:59:28
In reply to Re: never tried MAOI's on heavy regiment now, sug. » temoigneur, posted by BrittPark on November 28, 2002, at 17:33:55
Tricyclics are generally not the AD of choice for treatment resistent depression and social anxiety; if used at all, they would most likely be used to augment an SSRI.
Mood stabilizers are fine to continue when starting an MAOI, either temporarily until the MAOI starts working, or as a continuing adjunct to an MAOI.
Shelli
Posted by Optimistic on November 29, 2002, at 10:59:24
In reply to Re: never tried MAOI's on heavy regiment now, sug.?? (nm), posted by temoigneur on November 28, 2002, at 22:44:01
I suffer from many of the problems that you have including the Tourette's. I never found any of the SSRI's helpful with my depression. I was wondering if they affected your Tourette's at all. I don't know if its the many years of depression, the anxiety or the use of so many different meds over the years, but I find that my Tourette's has gotten worse. I have never tried an MAOI.
Posted by BrittPark on November 29, 2002, at 19:58:13
In reply to Re: never tried MAOI's on heavy regiment now, sug. » BrittPark, posted by ShelliR on November 28, 2002, at 18:59:28
Do you have some references that show that tricyclics are ineffective for SP. My understanding of the current state of the art is that SSRIs and tricyclics are equally likely to be effective for SP or at least that there is no reason to believe that TCAs are not as effective. I do understand that MAOI are supposed to have a slight advantage in treating depression and SP. However MAOIs are usually saved til last as they are by far the most dangerous ADs. Personally if I were in his position I would try a TCA first because they are much easier to handle than MAOIs
However, De gustibus.Cheers,
Britt
Posted by temoigneur on November 29, 2002, at 20:20:02
In reply to Re: never tried MAOI's on heavy regiment now, sug., posted by BrittPark on November 29, 2002, at 19:58:13
Hi Britt, thanks for your suggestions, actually my main problem is OCD, panic attacks, and constant free floating anxiety - I know, fun. I've tried some tricyclics, ie imipramine, and the tricyc, indicated for OCD - anafranil, imipramine did lower my anxiety level but it left me sedated and dull. I've tried every category of mainline drugs, I think, except for MAOI's, and I have read reports where for some people they do wonders with the panic, and occassionally OCD. You are right about the dangers, and dietary restrictions though, at this point I'd be willing to eat tofu for the rest of my life, if it meant having just two years where I felt myself. Thanks again for your input.
Ben
Posted by BrittPark on November 29, 2002, at 22:08:33
In reply to Re: never tried MAOI's on heavy regiment now, sug., posted by temoigneur on November 29, 2002, at 20:20:02
It sounds like an MAOI for you. I understand completely. If I could have a guarantee that I would feel better I'd gladly eat only eggplant (which I hate).
Good luck,
Britt
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