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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by f l y on January 14, 2004, at 16:04:28
i'm at 70mg parnate - having trouble w/ sleeping in and having a need to take naps even though i've had full nights sleep. my pdoc won't write a higher dose of parnate or a stim besides provigil (bad s/e) until he gets a second opinion from a more maoi experienced pdoc. i don't like the extra expense and time. there is a need for pdocs to get more up to date on maoi's.
Posted by Jasmine on January 14, 2004, at 16:17:27
In reply to pdoc making me jump hoops for maoi's, posted by f l y on January 14, 2004, at 16:04:28
I agree it's hard these days to find doctors knowledgable about MAOIs mainly because today they are all trained to push the newer classes of antidepressants. I understand it's frustrating, however, I think it's a sign you have a good and responsible doctor who asks for others opinions rather than just writing prescriptions for something he/she may not know much about.
Jasmine @>-->--
Posted by brussell on January 14, 2004, at 16:37:39
In reply to Re: pdoc making me jump hoops for maoi's, posted by Jasmine on January 14, 2004, at 16:17:27
70mg/day is a little high. I've heard of people going higher, but I think it's a really good sign that:
a> your pdoc will prescibe MAOI's--many are scared to death of them.
b> your doc will admit when he doesn't know something. A doctor who doesn't think he knows everthing is worth his weight in gold.
Posted by sailor on January 14, 2004, at 22:32:36
In reply to Re: pdoc making me jump hoops for maoi's, posted by brussell on January 14, 2004, at 16:37:39
There's a woman on PB who's been taking 100mg/da Parnate and doing well. Jessica is the name she's been at 100 mg for 10 months and calls it a "life saver". Also a study with treatment resistant depressives at U of Penn. Med School, they dosed subjects at a range from 90 to 170 mg/day. They reported no unusual side effects and positive results, although conducted with only seven "refractory depressed patients."
Coincidentaaly, I am on a Parnate trial and saqw my nurse practitioner about moving up my dosage from the 30/day she had me on. She agreed to go only to 60, because that is the PDR guideline and also Glaxo Smith Kline's (the manufacturer. However, as we know from PB contributors, "off label" dosages and useages are often effective and safe for lots of patients. The conservatism about Parnate is due I believe to worry about law suits from "cheese reactions" and the drug companies have been pushing "safer" drugs to docs as a marketing strategy. That's too bad about Parnate because it is one of the most effective drugs for a small class of treatment resistant depressives, and has been truly "miraculous" for many.
I am starting at 60 mg today and go back in 3 weeks for f/u. If I think it is beginning to help, and I'm not having side effect problems (so far nothing serious--some drowsiness, low appetite, mild orgasmic difficulty. No BP changes at all), I will argue strongly for the right to increase my dose. I f I can't get cooperation I'll have to seek help elsewhere, as I don't believe in giving up on a drug prematurely after investing lots of time and money, and sometimes suffering. Of course, there's a chance tto, that these next 3 weeks may tell me Parnate is a big problem and I won't want to continue. But I do insist on the right to participate in my health care decisions and some practitioners are clearly threatened by that.
PARNATE USERS: please post your past and/or current experiences with this drug for the benefit of those of us now tring it. I will continue to post as soon as I have useful updated experience. Thanks to all of you Patience and persistence to all. Regards, Sailor
Posted by Maxime on January 15, 2004, at 10:18:03
In reply to Re: pdoc making me jump hoops for maoi's, posted by sailor on January 14, 2004, at 22:32:36
Actually Jessica is up to 120 mg of Parnate now. I've heard of people needing to go as high as 140 mg.
Too bad docs act as though the PDR is the bible!
Maxime
> There's a woman on PB who's been taking 100mg/da Parnate and doing well. Jessica is the name she's been at 100 mg for 10 months and calls it a "life saver". Also a study with treatment resistant depressives at U of Penn. Med School, they dosed subjects at a range from 90 to 170 mg/day. They reported no unusual side effects and positive results, although conducted with only seven "refractory depressed patients."
> Coincidentaaly, I am on a Parnate trial and saqw my nurse practitioner about moving up my dosage from the 30/day she had me on. She agreed to go only to 60, because that is the PDR guideline and also Glaxo Smith Kline's (the manufacturer. However, as we know from PB contributors, "off label" dosages and useages are often effective and safe for lots of patients. The conservatism about Parnate is due I believe to worry about law suits from "cheese reactions" and the drug companies have been pushing "safer" drugs to docs as a marketing strategy. That's too bad about Parnate because it is one of the most effective drugs for a small class of treatment resistant depressives, and has been truly "miraculous" for many.
> I am starting at 60 mg today and go back in 3 weeks for f/u. If I think it is beginning to help, and I'm not having side effect problems (so far nothing serious--some drowsiness, low appetite, mild orgasmic difficulty. No BP changes at all), I will argue strongly for the right to increase my dose. I f I can't get cooperation I'll have to seek help elsewhere, as I don't believe in giving up on a drug prematurely after investing lots of time and money, and sometimes suffering. Of course, there's a chance tto, that these next 3 weeks may tell me Parnate is a big problem and I won't want to continue. But I do insist on the right to participate in my health care decisions and some practitioners are clearly threatened by that.
> PARNATE USERS: please post your past and/or current experiences with this drug for the benefit of those of us now tring it. I will continue to post as soon as I have useful updated experience. Thanks to all of you Patience and persistence to all. Regards, Sailor
Posted by jerrympls on January 17, 2004, at 23:18:52
In reply to pdoc making me jump hoops for maoi's, posted by f l y on January 14, 2004, at 16:04:28
> i'm at 70mg parnate - having trouble w/ sleeping in and having a need to take naps even though i've had full nights sleep. my pdoc won't write a higher dose of parnate or a stim besides provigil (bad s/e) until he gets a second opinion from a more maoi experienced pdoc. i don't like the extra expense and time. there is a need for pdocs to get more up to date on maoi's.
I feel for you. It's too bad dr's are so scared of MAOI's. I would suggest going to a University research hospital if you can. The Doc's are eager to use MAOI's in certain cases and know everything about them - well, in my situtation that has been the case. At any rate, I thought these abstracts would help you regarding adding a stimulant to an MAOI:
1: J Clin Psychopharmacol. 1991 Apr;11(2):127-32.
CNS stimulant potentiation of monoamine oxidase inhibitors in treatment-refractory depression.
Fawcett J, Kravitz HM, Zajecka JM, Schaff MR.
Department of Psychiatry, Rush-Presbyterian-St. Luke's Medical Center, Chicago, llinois.
We report on our clinical experience with a combination of a CNS stimulant (either pemoline or dextroamphetamine) and a monoamine oxidase inhibitor (MAOI) for treating 32 depressed patients (mainly outpatients) refractory to standard antidepressant pharmacotherapy. This combination, though not approved by the FDA, appears to be safe and effective. Twenty-five (78%) of these patients experienced at least 6 months of symptom remission with a stimulant + MAOI combination. Many patients required adjunctive antidepressant treatment, including tricyclics and lithium. Side effects were not excessive, though 6 patients (3 unipolar and 3 bipolar) cycled to mania (N = 1) or hypomania (N = 5). None developed hypertensive crises. With properly motivated and complaint patients and careful clinical monitoring by the prescribing psychiatrist, stimulant potentiation of MAOIs may be a viable option for treatment-resistant depressed patients.
PMID: 2056139 [PubMed - indexed for MEDLINE]
2: J Clin Psychiatry. 1985 Jun;46(6):206-9.
Combined MAOI, TCA, and direct stimulant therapy of treatment-resistant depression.
Feighner JP, Herbstein J, Damlouji N.
Patients with "treatment resistant" depression who do not respond to standard methods or relapse over time have a moral and legitimate right to innovative therapy. Combined treatment with monoamine oxidase inhibitors (MAOIs), tricyclic antidepressants (TCAs), and stimulants has been resisted by practitioners because of hypertensive and hyperthermic crises noted in certain cases This paper reports a case series demonstrating the safety and efficacy of adding a stimulant to an MAOI or to a combination of TCA and MAOI in the treatment
of intractable depression.PMID: 3997787 [PubMed - indexed for MEDLINE]
Posted by micro on January 19, 2004, at 1:12:41
In reply to Re: pdoc making me jump hoops for maoi's, posted by jerrympls on January 17, 2004, at 23:18:52
> > i'm at 70mg parnate - having trouble w/ sleeping in and having a need to take naps even though i've had full nights sleep. my pdoc won't write a higher dose of parnate or a stim besides provigil (bad s/e) until he gets a second opinion from a more maoi experienced pdoc. i don't like the extra expense and time. there is a need for pdocs to get more up to date on maoi's.
> I feel for you. It's too bad dr's are so scared of MAOI's. I would suggest going to a University research hospital if you can. The Doc's are eager to use MAOI's in certain cases and know everything about them - well, in my situtation that has been the case. At any rate, I thought these abstracts would help you regarding adding a stimulant to an MAOI:
>
> 1: J Clin Psychopharmacol. 1991 Apr;11(2):127-32.
>
> CNS stimulant potentiation of monoamine oxidase inhibitors in treatment-refractory depression.
>
> Fawcett J, Kravitz HM, Zajecka JM, Schaff MR.
>
> Department of Psychiatry, Rush-Presbyterian-St. Luke's Medical Center, Chicago, llinois.
>
> We report on our clinical experience with a combination of a CNS stimulant (either pemoline or dextroamphetamine) and a monoamine oxidase inhibitor (MAOI) for treating 32 depressed patients (mainly outpatients) refractory to standard antidepressant pharmacotherapy. This combination, though not approved by the FDA, appears to be safe and effective. Twenty-five (78%) of these patients experienced at least 6 months of symptom remission with a stimulant + MAOI combination. Many patients required adjunctive antidepressant treatment, including tricyclics and lithium. Side effects were not excessive, though 6 patients (3 unipolar and 3 bipolar) cycled to mania (N = 1) or hypomania (N = 5). None developed hypertensive crises. With properly motivated and complaint patients and careful clinical monitoring by the prescribing psychiatrist, stimulant potentiation of MAOIs may be a viable option for treatment-resistant depressed patients.
>
> PMID: 2056139 [PubMed - indexed for MEDLINE]
>
>
>
> 2: J Clin Psychiatry. 1985 Jun;46(6):206-9.
>
> Combined MAOI, TCA, and direct stimulant therapy of treatment-resistant depression.
>
> Feighner JP, Herbstein J, Damlouji N.
>
> Patients with "treatment resistant" depression who do not respond to standard methods or relapse over time have a moral and legitimate right to innovative therapy. Combined treatment with monoamine oxidase inhibitors (MAOIs), tricyclic antidepressants (TCAs), and stimulants has been resisted by practitioners because of hypertensive and hyperthermic crises noted in certain cases This paper reports a case series demonstrating the safety and efficacy of adding a stimulant to an MAOI or to a combination of TCA and MAOI in the treatment
> of intractable depression.
>
> PMID: 3997787 [PubMed - indexed for MEDLINE]
>
> I AGREE TOTALLY! Maoi's rap is worse than its benefit for some people, just ask Dick Cavett!Mainly due to the lack of experience of pdocs to use them and bx benzo,s and ssri's are less risky and easier to rx and dose for Pcp's as well. What is really needed is doc experience.True Psychopharmacologists are few and far between so definitely do not overlook the teaching institutions with great reputations and large amounts of researchers who are well published. Micro
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