Should I take a MAOI?
Question:
I have tried paxil, then effexor my doc thinks i should try parnate are there safer meds i should be trying first? thanks in advance cybercafe
Response:
I saw your posts in the Manerix thread, so I guess you’re already aware of my experience with this product. The question is if it is available where you are. What about Parnate? Is it reversible? Does it affect the same neurotransmitters? If it’s easier for you to find, why not try it? If SSRIs didn’t work for you and your depression is rather atypical, MAOIs can be a good choice.
– Hide quoted text — Show quoted text -> I have tried paxil, then effexor > my doc thinks i should try parnate > are there safer meds i should be trying first? > thanks in advance > cybercafe
Response:
my doc said the worst thing i have to fear from a MAOI in all likelihood is a headache…. how accurate does that sound? how bad is a hypotensive crisis likely to be ? i hear moclobemide isn’t as affective and nardil causes light-headedness because all the blood goes to your feet oh i’m bipolar type II (mainly depression, some hypomania) btw
– Hide quoted text — Show quoted text -> I saw your posts in the Manerix thread, so I guess you’re already aware of > my experience with this product. The question is if it is available where > you are. > What about Parnate? Is it reversible? Does it affect the same > neurotransmitters? If it’s easier for you to find, why not try it? > If SSRIs didn’t work for you and your depression is rather atypical, MAOIs > can be a good choice.
Response:
> my doc said the worst thing i have to fear from a MAOI in all likelihood is > a headache…. how accurate does that sound?
That, and some insomnia, but the great thing is as soon as your morning pill takes effect, you don’t feel like you hadn’t much sleep. It’s like I needed less sleep now. But maybe I just could stop drinking coffee. > how bad is a hypotensive crisis likely to be ?
As far as I know, MAOIs rather tend to induce hypertension, not hypotension. > i hear moclobemide isn’t as affective and nardil causes light-headedness > because all the blood goes to your feet
If Parnate is more effective than Manerix, it must very effective. Besides, I did a little search, and side effects also seem to be heavier.
Response:
Oh, and while we’re at it, if that matters to you, Manerix as a very positive effect on my libido… Wish I had a girlfriend right now, she would find me rather… let’s say, intense?
– Hide quoted text — Show quoted text -> my doc said the worst thing i have to fear from a MAOI in all likelihood is > a headache…. how accurate does that sound? > how bad is a hypotensive crisis likely to be ? > i hear moclobemide isn’t as affective and nardil causes light-headedness > because all the blood goes to your feet > oh i’m bipolar type II (mainly depression, some hypomania) btw
Response:
Tranylcypromine (Parnate) is very effective, typically more so than moclobemide (Manerix). They are technically different classes of drug. The former is ‘irreversible’ and nonselective, inhibiting MAOI type A and B, whereas the latter is a RIMA (Reversible Inhibitor of Monoamine oxidase type-A). Have a look at this page: http://www.biopsychiatry.com/tranylmoc.htm Tranylcypromine has a tendency to induce hypertensive crises more often than the other nonselective, irreversible MAOI-type drugs (isocarboxazid, phenelzine). More of a common concern than the hypertensive crises that could afflict you if you consume too much tyramine, is the tendency for the MAOIs to induce hypotension. This is common amongst these drugs, and not solely limited to phenelzine (Nardil). However, the orthostatic hypotensive effects of the MAOIs appear in the majority of patients to resolve and are surprisingly replaced by significant but asymptomatic and transient increases in blood pressure later on. As for how bad the hypertensive crises are likely to be, it all depends on how much tyramine you consume. It takes only a small quantity of cheese but a large quantity of wine or beer to precipitate a hypertensive crisis. The rule is simply to avoid these foods altogether. You should not experience much in the way of symptoms if you stick to the diet. Moclobemide might well be worth trying. If it works, you don’t have the dietary restrictions, even though you are advised to be wary of consuming too much pressor amine-containing food. I’m interested to know why you are thinking about MAOI-related drugs after having tried so few others. You may be taking on a life of very boring meals if you decide this early in the game to take Parnate. If you are an anxious insomniac type of person, there may well be more tolerable drugs than the rather activating Parnate. They would certainly be easier to take in the long term, although I admit that there are few drugs that are as effective for severe depression than Parnate. Hope this helps, Vitriholic
– Hide quoted text — Show quoted text -> my doc said the worst thing i have to fear from a MAOI in all likelihood is > a headache…. how accurate does that sound? > how bad is a hypotensive crisis likely to be ? > i hear moclobemide isn’t as affective and nardil causes light-headedness > because all the blood goes to your feet > oh i’m bipolar type II (mainly depression, some hypomania) btw > I saw your posts in the Manerix thread, so I guess you’re already aware of > my experience with this product. The question is if it is available where > you are. > What about Parnate? Is it reversible? Does it affect the same > neurotransmitters? If it’s easier for you to find, why not try it? > If SSRIs didn’t work for you and your depression is rather atypical, MAOIs > can be a good choice.
Response:
I’ve been on Parnate for several months now. After trying more anti-depressants than I can count in the other groups my doctor suggested I try an MAOI. This is not an idle decision – the diet is very important! In general, MAOI’s lower your blood pressure. In fact I get my blood pressure checked frequently and my doctor is always asking if I feel dizzy upon rising to make sure it doesn’t go too low. It’s a good way to make sure you’re not taking too much too. However, when you ingest foods containing tyramine your blood pressure will rise. If you ingest too much you will have a "hypertensive episode". Any doctor that prescribes an MAOI should also prescribe an emergency pill to counter the effects of rapidly rising blood pressure. If left unchecked you can go into cardiac arrest and possibly die. So the repercussions are very serious. My doctor gave me thorazine as a counter drug. I only take it if I have an episode. This has happened to me twice. The symptoms (for most people) are migraine first. This is the only time in my life I have had a serious migraine. Both times the pain was so intense I felt like crying. It comes on extremely fast and is severe. Taking the thorazine greatly helped. Within an hour it felt like a normal headache again. I was tired for about 24-48 hours and headachy for a couple weeks on and off after each attack. Both times were caused by accidentally eating something in a restaurant. (The first time was clams in stew and I later called the restaurant and found out they were smoked, canned clams. The second time I ate some Pho soup and it had anchovy paste in it – I had no idea.) The side-effects in general aren’t too bad. It makes it difficult to sleep, but I take trazadone or klonopin for that. And it’s also important for me to take my first dose at around the same time every day or I feel dizzy and just kind of out of it and by the time I remember to take it if I’m late it takes an hour or two to feel normal again. I take a very high dose though. I am not bi-polar but have been diagnosed as having treatment resistant depression. For those with TRD they sometimes suggest taking a dose up to 130mg. A normal dose only goes up to 60mg. I take 100mg. So, the bottom line is – these are my experiences, others may have slightly different reactions. I have heard that headache can be a possible side-effect, but other that after my migraine I have not had that. The most important thing I can say is that it is crucial to learn what foods contain tyramine and stick to the diet religiously. It’s not quite as restrictive as it used to be. If you look into it make sure you are looking at lists after 1996. They redid the lists and made them less restrictive. For example, mozzarella cheese and other fresh cheeses (like chevre, montrachet, cream cheese, etc.) are okay – you really have to avoid aged cheeses. I can eat pizza still, I just have to make sure it made by someone who doesn’t add parmesan or mix the mozzarella with other cheeses. You’ll find you are often asking about the ingredients in items when you eat out. Well, kind of wordy – but I hope that helps! -Jessica
– Hide quoted text — Show quoted text -> my doc said the worst thing i have to fear from a MAOI in all likelihood is > a headache…. how accurate does that sound? > how bad is a hypotensive crisis likely to be ? > i hear moclobemide isn’t as affective and nardil causes light-headedness > because all the blood goes to your feet > oh i’m bipolar type II (mainly depression, some hypomania) btw > I saw your posts in the Manerix thread, so I guess you’re already aware of > my experience with this product. The question is if it is available where > you are. > What about Parnate? Is it reversible? Does it affect the same > neurotransmitters? If it’s easier for you to find, why not try it? > If SSRIs didn’t work for you and your depression is rather atypical, MAOIs > can be a good choice.
Response:
> > my doc said the worst thing i have to fear from a MAOI in all likelihood > is > a headache…. how accurate does that sound? > That, and some insomnia, but the great thing is as soon as your morning pill > takes effect, you don’t feel like you hadn’t much sleep. It’s like I needed > less sleep now. But maybe I just could stop drinking coffee.
oh…. jessica says below that a hypertensive crisis is a possibility… ? > how bad is a hypotensive crisis likely to be ? > As far as I know, MAOIs rather tend to induce hypertension, not
hypotension. sorry, that’s what i meant, hypertensive crisis > i hear moclobemide isn’t as affective and nardil causes light-headedness > because all the blood goes to your feet > If Parnate is more effective than Manerix, it must very effective. Besides, > I did a little search, and side effects also seem to be heavier.
damn… maybe i should take Manerix first…. the reason why my doc wants me to try an MAOI is because he says effexor works on certain dense norepenephrine and 5HT areas, and if those areas aren’t what needs targetting, the next step is to move on to the midbrain with an MAOI
Response:
> Oh, and while we’re at it, if that matters to you, Manerix as a very > positive effect on my libido… Wish I had a girlfriend right now, she would > find me rather… let’s say, intense?
of course it matters to me… 
… i’ve taken paxil before 
now that you’re feeling okay, it should be the easiest time for you to get a GF, no? – Hide quoted text — Show quoted text -> my doc said the worst thing i have to fear from a MAOI in all likelihood > is > a headache…. how accurate does that sound? > how bad is a hypotensive crisis likely to be ? > i hear moclobemide isn’t as affective and nardil causes light-headedness > because all the blood goes to your feet > oh i’m bipolar type II (mainly depression, some hypomania) btw
Response:
> Tranylcypromine (Parnate) is very effective, typically more so than > moclobemide (Manerix). They are technically different classes of drug. The > former is ‘irreversible’ and nonselective, inhibiting MAOI type A and B, > whereas the latter is a RIMA (Reversible Inhibitor of Monoamine oxidase > type-A). Have a look at this page:
in what sense is it irreversible? > solely limited to phenelzine (Nardil). However, the orthostatic hypotensive > effects of the MAOIs appear in the majority of patients to resolve and are > surprisingly replaced by significant but asymptomatic and transient > increases in blood pressure later on.
how much later are we talking here? > rule is simply to avoid these foods altogether. You should not experience > much in the way of symptoms if you stick to the diet.
of course my fear is that i eat something out where it is not obvious there is cheese in the ingredients, and then keel over dead i just don’t know how realistic a scenario that is > Moclobemide might well be worth trying. If it works, you don’t have the > dietary restrictions, even though you are advised to be wary of consuming > too much pressor amine-containing food.
what’s a pressor amine? > having tried so few others. You may be taking on a life of very boring meals > if you decide this early in the game to take Parnate. If you are an
anxious my doc recommended it because it was his belief that if paxil and effexor don’t work, it’s time to try a different brain area (hence an MAOI) i may have misunderstood, but he also seemed to believe that the worst i can expect from a hypertensive crisis is a bad headache.. the other symptoms (death) are overstated > insomniac type of person, there may well be more tolerable drugs than the > rather activating Parnate. They would certainly be easier to take in the > long term, although I admit that there are few drugs that are as effective > for severe depression than Parnate.
no i sleep too much, but you’re right, i certainly do not want any diet restrictions
Response:
> of course my fear is that i eat something out where it is not obvious there > is cheese in the ingredients, and then keel over dead > i just don’t know how realistic a scenario that is
I actually allow myself some cheese… Even parmesan on my pasta! I just blame myself if I get a headache after, but it’s not that bad. From what I read, interaction is much worse with Parnate. If you like fresh cheese like cottage or cream cheese, you can have as much as you want, since the tyramide is produced in the aging process.
Response:
I have a bit of parmesan too – it doesn’t seem to effect me if I don’t have much. RE: the keel over dead fear – you won’t instantly die!!! You will have plenty of warning physically before you get to the point of heart attack. If you take your emergency pill and/or call 911 you’ll be just fine. -Jessica
– Hide quoted text — Show quoted text -> of course my fear is that i eat something out where it is not obvious > there > is cheese in the ingredients, and then keel over dead > i just don’t know how realistic a scenario that is > I actually allow myself some cheese… Even parmesan on my pasta! I just > blame myself if I get a headache after, but it’s not that bad. From what I > read, interaction is much worse with Parnate. If you like fresh cheese like > cottage or cream cheese, you can have as much as you want, since the > tyramide is produced in the aging process.
Response:
> > of course my fear is that i eat something out where it is not obvious > there > is cheese in the ingredients, and then keel over dead > i just don’t know how realistic a scenario that is > I actually allow myself some cheese… Even parmesan on my pasta! I just > blame myself if I get a headache after, but it’s not that bad. From what I > read, interaction is much worse with Parnate. If you like fresh cheese like > cottage or cream cheese, you can have as much as you want, since the > tyramide is produced in the aging process.
hmm.. so you’re taking manerix/moclobemide right? … yeah i think i’ll push for that one.. though i think my doc said it only works for 2 out of 10 people whereas parnate works for like 10/10 people (i could be really confused-misquoting here, .. would appreciate input) so wait a sec here…. is that the worst that can happen on manerix, a headache? … is there a chance of you accidentally eating something worse? … like if you eat out all the time
Response:
> RE: the keel over dead fear – you won’t instantly die!!! You will have > plenty of warning physically before you get to the point of heart attack. > If you take your emergency pill and/or call 911 you’ll be just fine.
thanks a lot for replying guys… i really appreciate the info i guess i am just afraid of coming off weird to friends….. like i wouldn’t want to have half of my dates cut short by me ending up in the emergency ward …. ummm…. after you take the thorazine you have to go to see a doc right? .. to see if your heart has returned to normal? why did my doc say something about cutting open the chest and sticking a needle (norepenephrine) in the heart? cheers cybercafe
Response:
> hmm.. so you’re taking manerix/moclobemide right? … yeah i think i’ll > push for that one.. though i think my doc said it only works for 2 out of 10 > people whereas parnate works for like 10/10 people (i could be really > confused-misquoting here, .. would appreciate input)
If it only work for 20% of people, then I’m definitely in that 20%. The good side is you will know very fast if it works or not. If you don’t notice any change in the first week, then you’ll know it doesn’t work for you. You should feel better on the second day if it does. > so wait a sec here…. is that the worst that can happen on manerix, a > headache? … is there a chance of you accidentally eating something worse? > … like if you eat out all the time
It’s the worst I’ve experienced, though sometimes I feel my heart beating faster and I have some difficulty sleeping (could be coffee, I drank a lot of it this week). I also noticed some stiffening in my legs in the last few days, but it could be because I walked more than usual this week, I’ve got too get my shape back. Go for fresh cheese and avoid preserved meat and alcohol, especially red wine, beer, and brown liquor (whisky, brandy, rhum, etc…) I think I’ll cut the coffee, too. All in all, the positive outweighs greatly the negative points. (In my case.) Besides, you should do a serious search on the long term effects of non-reversible MAOIs like Parnate… High efficiency has a price.
Response:
I’m on Parnate, haven’t tried Manerix. I don’t understand your doctor – maybe he just wanted to let you know the absolute worst case scenario. After you take the thorazine you don’t need to see anyone. If you’re feeling better, chances are your blood pressure is returning to normal. I would recommend getting a home blood pressure kit (I don’t have one yet, but plan on purchasing an automatic one). It’s good to have a baseline blood pressure measurement (I take mine every two weeks) and it’s also a helpful diagnostic when you’re having an attack and after you are feeling better. It’s a little awkward when I eat at restaurants, but it’s just like people with food allergies – they have to ask about ingredients and occasionally make special orders too. I just order simpler foods and ask for no cheese. The hardest part for me is giving up my Mexican food with melted cheddar. Mmmm. Also – I still eat ethnic, but you have to be a bit more careful, especially with Asian foods. Again – you just need to know what you’re eating. You really shouldn’t be afraid of Parnate though. Like I said, it’s like having a food allergy. Definitely non-life-threatening. Good luck, Jessica
– Hide quoted text — Show quoted text -> RE: the keel over dead fear – you won’t instantly die!!! You will have > plenty of warning physically before you get to the point of heart attack. > If you take your emergency pill and/or call 911 you’ll be just fine. > thanks a lot for replying guys… i really appreciate the info > i guess i am just afraid of coming off weird to friends….. > like i wouldn’t want to have half of my dates cut short by me ending up in > the emergency ward …. > ummm…. after you take the thorazine you have to go to see a doc right? .. > to see if your heart has returned to normal? > why did my doc say something about cutting open the chest and sticking a > needle (norepenephrine) in the heart? > cheers > cybercafe
Response:
Hi, you seem well informed about diet issues with MAOIs. Do you happen to know if coffee contains tyramine, or if cafeine has any bad interactions with MAOIs? I’m beginning to wonder if my daily double espresso shot in the morning is fully compatible with my Manerix (I know you’re on Parnate, but it’s the same food restrictions…) I think I’ll stop drinking coffee to see if I can sleep better at night.
Response:
I’ve done a lot of research about diet restrictions and the latest information. Caffeine is okay in moderation. 1-2 cups or so if okay. I have had double shots of espresso and been fine, but I try not to have any more than that. As for sleep – the caffeine in the coffee has the same effect whether you’re on the med or not. So if it made you have trouble sleeping before then it still will. I have to remind you that my knowledge is Parnate based – I really don’t know anything about Manerix. I know that Parnate causes trouble sleeping and I take Trazadone to help me sleep. I also tried Klonopin which is another "clean" sleeping aid. I doubt caffiene in the morning is going to effect your sleep at night – it’s probably the med. Ask your doctor about it. -Jessica
– Hide quoted text — Show quoted text -> Hi, you seem well informed about diet issues with MAOIs. Do you happen to > know if coffee contains tyramine, or if cafeine has any bad interactions > with MAOIs? I’m beginning to wonder if my daily double espresso shot in the > morning is fully compatible with my Manerix (I know you’re on Parnate, but > it’s the same food restrictions…) I think I’ll stop drinking coffee to see > if I can sleep better at night.
Response:
– Hide quoted text — Show quoted text -> Hi, you seem well informed about diet issues with MAOIs. Do you > happen to know if coffee contains tyramine, or if cafeine has any bad > interactions with MAOIs? I’m beginning to wonder if my daily double > espresso shot in the morning is fully compatible with my Manerix (I > know you’re on Parnate, but it’s the same food restrictions…) I > think I’ll stop drinking coffee to see if I can sleep better at night. > Quit talking about Manerix as if it’s a real MAOI, with the same food > restrictions. It’s a RIMA and it’s hardly comparable with irreversible > MAOI’s like Parnate or Nardil! I ate salami pizza’s while on moclobemide. > Wouldn’t take that risk with Parnate. Parnate worked -for a while- and > moclobemide did shit for me. Not even gave me side effects (which was very > pleasant, by the way, but still… I felt like taking a placebo).
Ooooh sorry… I’ll stop pretending to be in the same league as the big boys taking real MAOIs with real diet restrictions… I’ll go back to the kindergarden with the other Manerix kids. How did I dare to believe I was worthy of the same side effects, I’m so ashamed of myself… Maybe it’s time I switch to something stronger, like Life Savers or Werther’s Originals… Do you think I could handle these? Any side effects? > "Patients on tranylcypromine therapy should also be advised not to consume > excessive amounts of caffeine in any form (coffee, tea, cola drinks, etc.) > because of possible enhanced effects of caffeine on the CNS." > No special warning for caffeine and moclobemide…
Ok, so I can eat anything with my baby pills, great.
Response:
> I’ve done a lot of research about diet restrictions and the latest > information. Caffeine is okay in moderation. 1-2 cups or so if okay. I > have had double shots of espresso and been fine, but I try not to have any > more than that. As for sleep – the caffeine in the coffee has the same > effect whether you’re on the med or not. So if it made you have trouble > sleeping before then it still will.
Maybe it’s just the combination of both… I’ll cut the coffey and see the results. > I have to remind you that my knowledge is Parnate based – I really don’t > know anything about Manerix. I know that Parnate causes trouble sleeping > and I take Trazadone to help me sleep. I also tried Klonopin which is > another "clean" sleeping aid. I doubt caffiene in the morning is going to > effect your sleep at night – it’s probably the med. Ask your doctor about > it.
Yeah, I see him today.
Response:
> Ooooh sorry… I’ll stop pretending to be in the same league as the big boys > taking real MAOIs with real diet restrictions… I’ll go back to the > kindergarden with the other Manerix kids. How did I dare to believe I was > worthy of the same side effects, I’m so ashamed of myself… Maybe it’s time > I switch to something stronger, like Life Savers or Werther’s Originals… > Do you think I could handle these? Any side effects?
I wouldn’t worry about it, I’ve taken both types… phenelzine, a big, bad nasty ol’ MAOI, did bugger all for me except making me watch my diet/blood pressure, but moclobemide, which didn’t even give me a hard time with cheese & marmite sarnies washed down with yeasty lager actually worked for a while (albeit briefly) Chris.
Response:
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