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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 rose45 on March 12, 2023, at 8:49:18
Has anyone had an MAOI poop out on them and had it work again at a later date?
Posted by SLS on March 12, 2023, at 20:40:14
In reply to maoi poop out, posted by rose45 on March 12, 2023, at 8:49:18
> Has anyone had an MAOI poop out on them and had it work again at a later date?
If you had the luxury of being prescribed Nardil, I would make the switch. I know two doctors who had their TRD patients rotate between Parnate and Nardil. With Nardil, doctors of old would have their patients take a "drug holiday" and abstain from taking Nardil for 3 months. Often, restarting Nardil after 3 months was able to recapture remission. I don't know about Parnate. What alternatate strategies has your doctor mentioned?
Might I suggest that you consider moving Parnate up to 60 mg/day and then add lithium 150-300 mg/day if necessary. Your last move is to move Parnate up to 80 mg/day.
What about adding lamotrigine?
- Scott
Posted by rose45 on March 13, 2023, at 10:52:49
In reply to Re: maoi poop out » rose45, posted by SLS on March 12, 2023, at 20:40:14
no, i have not been prescribed Nardil by the NHS, so I would have to source it myself, and my brain is just not working and i would not dare do the swap without supervision.
I was on 30mg parnate for six years, and simply cannot tolerate above 40mg.It was the same with nardil, I just could not tolerate doses higher than 60mg.
I mentioned in an earlier post that 200 mg lamotrigine was added and worked for 3 months and then stopped working, and it ruined my memory and ability to communicate or concentrate so I hate that drug, and am reducing, and almost off it. Also the NHS told me I had to come off it as their rules insist no more than 3 meds at one time. You see how everything is stacked up against me.
I did add 150mg lithium on the advice of a psychiatrist in Mexico who I consulted by whatsapp and it worked for 2 months, and then stopped
working and the anxiety came back with a vengeance.Why does everything stop working?
Can you see why I have lost all hope?
The NHS are giving me the choice of lithium, valproic acid or pregabalin. But even they do not think those meds will get me to how I was before.
How can I ever get better?
Im writing in desperaton. Any thoughts most gratefully received.
Posted by SLS on March 13, 2023, at 12:30:43
In reply to Re: maoi poop out » SLS, posted by rose45 on March 13, 2023, at 10:52:49
Hi, Rose.
> Why does everything stop working?
Well, I wouldn't use the performance of any one drug to indicate your ultimate responsiveness to treatment. There are just too many permutations of drug combinations I doubt that you have explored.
What is it about Parnate 60 mg/day and Nardil 75 mg/day that prevents you from continuing treatment?
> Can you see why I have lost all hope?
Yes.
I have come very close to losing all hope several times. I had come to the point of making plans for how best to protect my money so that it not be used for my burial. A person with a chronic and unremitting case of depression has sufficient reason to auto-euthanize themselves. Allow me to suggest that you are not there yet.
> How can I ever get better?
I have a bunch of ideas.
At the bottom of this post, I will list my previous reactions to drug monotherapy over the course of 40 years.
I NEVER responded adequately to any one drug. My two remissions (lasting more than a week) necessitated the combining of a MAOI with a tricyclic.
All four of the following drugs are necessary for my achieving remission:
Nardil - 90 mg/day
Nortriptyline - 100 mg/day
Lamictal - 300 mg/day
Lithium - 150-300 mg/day- If I take away any one drug, I relapse.
- If I reduce the dosage of any one drug, I relapse.This is the best example I can think of that demonstrates how exacting one must be in choosing drugs and their dosages.
I'm still unclear on something. What exactly did you do such that you lost your remission?
> But even they do not think those meds will get me to how I was before.
Their thinking is little more than a guess. Perhaps they guessed wrong.
- Scott
Posted by SLS on March 14, 2023, at 23:05:20
In reply to Re: maoi poop out » SLS, posted by rose45 on March 13, 2023, at 10:52:49
Hi, Rose.
I forgot to provide the list of drugs I've taken over the last 40 years. I began my ascent to remission about 1/2 years ago. In those 40 years, I had only 6 months of respite when I responded to Parnate 60 mg/day + desipramine 150 mg/day. Even those 6 months weren't a 100% improvement. However, I became manic after the 6 months, and my doctor had me stop both medications. When I relapsed 1 month later, he decided to play with Prozac, which had just been approved. It didn't work, but he refused to put me back on what did work - even if too well. But that was standard operating procedure in 1987. With 20/20 hindsight, it might have been better to have left me on the combo, but add lithium + clonazepam (Klonopin) to put a lid on the mania. I'll have to wait until tomorrow to write more.
F*ck it. Please don't tell my fiancee that I was up at midnight.
------------------------
My knee-jerk reaction is that you should switch to Nardil, and titrate it VERY gradually.The second wave of psychopharmacologists (1980s) discovered a strategy for people who relapse on Nardil, even after years of remission. They learned that if you discontinue Nardil for 3 months, and then restart it, you can see it work again.
Example:
7.5 mg/day (1/2 pill) for 1-2 weeks.
15 mg/day for another 2 weeks.
30 mg/day for 3 weeks.
45 mg/day for 3 weeks.
60 mg/day for 3-5 weeks.
75 mg/day for 3-5 weeks
90 mg/day if necessary.With Nardil, it can take 3 months to receive a big-time response to it.
Question: How long should you wait from the time you take your last Parnate pill to when you take your first Nardil pill?Answer: 10-14 days.
What we have done here is to use our best guesses about *clinical* psychiatry. No knowledge or theories about neurotransmitters and receptors are necessary to get well.* I have been on Nardil at least 10 times. I *always* suffered side-effects, especially dizziness and the inability to urinate. I would spend 30-45 minutes sitting on the toilet to get it to happen. The alternative was to get catheterized every time I needed to take a piss. This time, I played out a hunch. I thought that if don't *trigger* the side-effects in the first place, you might not get them. So, I decided to try titrating very slowly - similar to the schedule I provided. I think it's worth a try. Unfortunately, clinical reactions to the same drug can be opposite when taken by two individuals, so I can't make any guarantees.
Then, you and your doctor can experiment with lithium and/or certain atypical antipsychotics. I do not glean a robust response to a treatment regime unless it contains a combination of MAOI and tricyclic (TCA) - desipramine, nortryptyline, doxepin, and perhaps trimipramine are usually safe to combine with Parnate or Nardil. Supposedly, you are supposed to start the tricyclic first, but I have combined them both ways. For me, the order doesn't matter.
---------------------------------------------------------------------------
This is the list I forgot to include in my earlier post to you:* This list includes drugs used as remedies for side effects, mostly for sleep and anxiety.
Total = 81
Adinazolam
Agomelatine
Alprazolam
Amitriptyline
Amoxapine
Amphetamine
Aripiprazole
Asenapine
Bromocriptine
Bupropion
Carbamazepine
Chloral Hydrate
Chlorpromazine
Clomipramine
Clonazepam
Clorgyline
Desipramine
Desvenlafaxine
Dexmethylphenidate
Donepezil
Doxycycline
Duloxetine
Escitalopram
Fluoxetine
Fluphenazine
Gabapentin
Idazoxan
Iloperidone
Imipramine
Indalpine
Isocarboxezid
Ketamine
Lamotrigine
Levitiracetam
Lithium
Lorazepam
Lurasidone
Memantine
Methylfolate
Methylphenadate
Mifepristone
Milnacipran
Minocycline
Mirtazapine
Moclobemide
Modafinil
Naltrexone (LDN)
Nomifensine
Nortriptyline
Olanzapine
Oxcarbazepine
Paroxetine
Pemoline
Perphenazine
Phenelzine
Prazosin
Pregabalin
Protriptyline
Quetiapine
Reboxetine
Risperidone
Selegiline
Sulpiride
Temazepam
Thioridazine
Thyroxine T4
Topiramate
Tranylcypromine
Trazodone
Triazolam
Triiodothyronine T3
Trimipramine
Valproate
Venlafaxine
Vilazodone
Viqualine
Vortioxetine
Zaleplon
Ziprasidone
Zolpidem
ZonisamideOf course, my treatment over the last 40 years included innumerable combinations of these drugs.
I haven't proofread this - not that proofreading ever helps me.
- Scott
Posted by PeterMartin on March 15, 2023, at 22:28:48
In reply to Re: maoi poop out » SLS, posted by rose45 on March 13, 2023, at 10:52:49
> I mentioned in an earlier post that 200 mg lamotrigine was added and worked for 3 months and then stopped working,
>> Why does everything stop working?
>Did the pharmacy/NHS give you a different generic "brand" of Lamotrigine at some point? (Re: did the pills shape/etc change?) There are lots of us who have issues w/ the various generic brands of lamotrigine and there are like 10 generic pharmaceutical companies (mostly in India/China) that source the medication. If your pharmacy ever switched you to a different maker's lamotrigine that can absolutely cause the medicine to stop working. It's very frustrating.
Posted by rose45 on March 19, 2023, at 10:33:04
In reply to Re: maoi poop out, posted by PeterMartin on March 15, 2023, at 22:28:48
>
> > I mentioned in an earlier post that 200 mg lamotrigine was added and worked for 3 months and then stopped working,
> >
>
> > Why does everything stop working?
> >
>
> Did the pharmacy/NHS give you a different generic "brand" of Lamotrigine at some point? (Re: did the pills shape/etc change?) There are lots of us who have issues w/ the various generic brands of lamotrigine and there are like 10 generic pharmaceutical companies (mostly in India/China) that source the medication. If your pharmacy ever switched you to a different maker's lamotrigine that can absolutely cause the medicine to stop working. It's very frustrating.Yes, it is too frustrating. I didnt even check at the time, because I was unaware of the problem with brands. But lamotrigine did subsequently work again for 3-4 weeks, and I made a note of the brand I had been given, and also bought some Lamictal original brand, but it made no difference, it just stopped working again.I am really desperate as no improvement seems to last.
This is the end of the thread.
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