MAO inhibitors

[fzzzbucs]

i been taking citalopram , i think it's called celexa in the u.s , for about 7 years . just lately i've been feeling really bad after having many good years with it... recently i've been seeing a lot of web sites refering to MAOIs and it does sound like a kind of wonder cure for sa apart from the food interactions. i was wondering if any of you guys have tried it . is it any good?

can i ask a gp in the uk to give me some?

here's a paragraph from medical website that a copied and pasted. would you agree with it?

thanks
fzzz
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MAOI's

The MAOI "Nardil" is definitely the MOST powerful and effective antidepressant for Social Phobia.

Nardil (phenelzine): Nardil usually works great for SP! It the "Gold Standard" antidepressant for SP. Nardil is excellent for many other anxiety and depressive disorders also. Reports of Nardil side effects are frequently exaggerated, particularly since Nardil's side effects typically take 2-4 months to diminish or disappear. After several months Nardil tends to cause less side effects than SRI's across comparable dose ranges, with the exception of Prozac. Dietary retrictions are quite minimal based on current information but incorrect and non-updated PDR information is used in most descriptions at present in books and online. (Hopefully an official list will be added here soon). Effective dose range for SP is usually 60-90mg/day. Nardil is usually initiated at a low dose, and increased gradually over a period of several weeks to months. A common error is starting too high or increasing too quickly, and working with a Dr. experienced in prescribing MAOI's is important. MAOI related "hypertensive crisis" is rare in responsible patients, and the risk is certainly overemphasized in most medical literature. Many experts consider the MAOI's to be underutilized. Although it has been reported that the MAOI's have seen a small resurgance in recent years, it is likely they will continue to be used sparingly by MD's. This could change if/when the FDA approves the "selegiline patch"

[Caedmon]

There are about four different commonly used MAOIs: Nardil (phenelzine), Parnate (tranylcypromine), Marplan (isocarboxazid), and various formulations of selegiline.

If citalopram isn't working so hot maybe you could ask about trying a new SSRI.

That website is probably the one by someone named Chad. It's not a medical website. There is some good information on it, and some value statements that are probably inaccurate. For example:

The MAOI "Nardil" is definitely the MOST powerful and effective antidepressant for Social Phobia.

Evidentiary Standpoint: I don't know if this has never been systematically studied. There is evidence that phenelzine is effect for treatment-resistant social phobia.
IMO: Probably some truth to this; response rates are about 20% higher for phenelzine and tranylcypromine than for other antidepressants in social phobia. The effect size also seems to be larger.

Nardil usually works great for SP!

ES: True. about 70% response rate off the top of my head.
IMO: Very individual. I've noticed a number of people have to go off phenelzine because of concerns about weight gain.

It the "Gold Standard" antidepressant for SP.

ES: hard to say, because this is a value statement, but in all likelihood this would go to Paxil (paroxetine). I believe that paroxetine is the most studied drug for social phobia and there isn't much doubt that it works.
IMO: really don't know one way or the other. MAOIs entail some big lifestyle changes, and not everyone is ready for that.

Reports of Nardil side effects are frequently exaggerated, particularly since Nardil's side effects typically take 2-4 months to diminish or disappear.

ES: Side effects are exaggerated, but they do exist and can be very bothersome. They include weight gain, hypotension, insomnia, tiredness, sexual dysfunction, and the possibility of addiction. "Nardil's side effects" may not diminish or disappear for more than 4 months, and some may not ever disappear or diminish. Weight gain, insomnia, and sexual dysfunction do not usually diminish at all.
IMO: Hypotension and insomnia are manageable. Weight gain, tiredness, and sexual dysfunction may or may not be dealbreakers. However, you'll never know whether it's tolerable or not if you never try it.

After several months Nardil tends to cause less side effects than SRI's across comparable dose ranges, with the exception of Prozac.

ES: I'm unaware of any evidence of this.
IMO: I am suspicious of this statement.

Dietary retrictions are quite minimal based on current information but incorrect and non-updated PDR information is used in most descriptions at present in books and online. (Hopefully an official list will be added here soon). Effective dose range for SP is usually 60-90mg/day. Nardil is usually initiated at a low dose, and increased gradually over a period of several weeks to months. A common error is starting too high or increasing too quickly, and working with a Dr. experienced in prescribing MAOI's is important. MAOI related "hypertensive crisis" is rare in responsible patients, and the risk is certainly overemphasized in most medical literature.

ES and IMO: all very true.

[fzzzbucs]

thanks for such a full and well informed answer.

i think i'll take your advice and ask for a different ssri. the truble is GPs in the uk are general practitioners of all kinds of health problems . they are not specialists in mental health care. he problably won't know what i'm talking about if i ask him for another ssri . oh well i'll give it a try anyway