Nardil/Parnate : Are they ever ineffective?

[jakejohnson007]

There are not many MAOI stories on this board, but from what I've read, MAOIs seem to help a lot of people.

I've been mining through posts, and it seems that most quit MAOIs because of dietary restrictions, difficutly of obtaining the meds, and/or side effects.


But, is there anyone out there for whom Nardil or Parnate did not alleviate social anxiety?


- JJ

[arthur56]

people mostly quit when they realise the med isnt going to work for them

all antidepressants may not work for a person, they must be taken for up to 6 weeks to find out whether they will work for you

IMO the MAOIs are very dangerous and should be a last resort only, many docs dont prescribe them

[jakejohnson007]

Originally Posted by arthur56

people mostly quit when they realise the med isnt going to work for them

Probably true, but I've read posts from lots of people for whom Nardil works and as of yet, no one has replied to this post to say that Nardil was ineffective at treating SA for them.

[quat]

Yeh, funny that, there's a lot of anecdotal evidence here to say that Nardil is the best drug for social anxiety. I had to pretty much beg my doctor to prescribe it to me, i quoted off a whole lot of MAOI literature to him telling him how safe it was. But yes another satisfied Nardil customer.

[No Limit]

MAOIs aren't as dangerous as most people make them out to be. I'm still able to eat pretty much what I want. Before you go to the dentist though or a doctor's appointment where anesthesia might be used, inform the doctor that you're taking an MOAI because the anesthetic might have a severe reaction to the MAOI. That's the only warning my pdoc has given me. Now I'm just worried if I get into an accident where I'm unconscious and I can't tell the paramedics that I'm on an MAOI, but I'm a careful person. I don't see that happening anytime soon.

Originally Posted by arthur56

IMO the MAOIs are very dangerous and should be a last resort only, many docs dont prescribe them

[Caedmon]

To answer your question: yes, there are most certainly people for whom MAOIs (or a particular MAOI, anyway), is/are insufficient or perhaps not tolerable. S#*! happens.

I could go on and on about how much the purported danger with MAOIs is blown out of proportion. I believe it's an outdated paradigm. I have to tell you, I've already lived with the risks that mental illness carry. Not leaving the house for a week straight, that's not my idea of good health.

I'm done - DONE - with 80% of my anxiety. My pdoc is now reducing antidepressants (there is a rationale for this) in an effort to get me to function more independently. I am pleased to consider how, before Parnate, I was spending days not leaving my house, moving from the floor to the bed to the floor, ordering pizza on a credit card and eating it within 20 minutes, freezing up just going to the grocery store out of fear for what my posture looked like, etc. It was a challenge to stay hygienic and shower on a semi-daily basis. NOW my challenges are managing my time while juggling grad school classes, clinical practicum, weekly presentations to peers and faculty, speaking to the parents/ caregivers of my clients, and attempting (lol) to write razor-sharp 60-minute essay exams. Others may not notice or not know me well: I know that for me it's a contrast. I still struggle, but what I struggle with now is at an entirely different level from what I worked against previously. I am EXTREMELY grateful I did my own independent research on the subject, and was also given a chance to evaluate the medication. If I could go back in time I'd have done the exact same thing, and I don't regret my decision.

Evidence in support of Nardil is much more sound than for Parnate wrt social anxiety, so keep this in mind when weighing the pros and cons of evaluating these medications.

[jakejohnson007]

Starting the Treatment and Choosing the Medication
The patient who suffers from Social Phobia looks for the doctor many years after his symptoms started (neither he nor us do know exactly when the disorder began). He comes from a lot of suffering without medical treatment (contrary to the panic disorder patients) and without hope relative to improvement. He thinks that he is like this and not that he is in a different state from before. Since the end of adolescence he spend most of the time suffering from the social anxiety symptoms and from the many difficulties involved, he does not consider himself as an ill person but as someone who is different.

We are (doctors, mental health professionals) in these cases in front of a disorder that is rather new in medicine. The same occurred with chronic minor depression or depressive personality, now treated or diagnosed as a sub-form of depression (dysthymia). Like in these new disorders the patient with Social Phobia will receive an indication for pharmacological treatment or psychotherapy with a lot of enthusiasm and huge doubts. "How a treatment will change my way of being?"

Controlled clinical trials in comparisons with placebo, in a double blind fashion have demonstrated that three drugs are efficacious in the treatment of Social Phobia: phenelzine (Nardil), clonazepam (Klonopin) or moclobemide (Aurorix). In an open study, after one year of follow up it was also demonstrated that tranylcypromine (Parnate) is also very efficacious.

These drugs are the ones best studied in the treatment of Social Phobia. Something that does not mean that others are not efficacious. Methodological and practical reasons result in delays in the demonstration of the efficacy of other drugs.

Despite the efficacy of the traditional inhibitors of monoamine oxidase (MAOIs) (phenelzine or tranylcypromine) we do not use them any more as first choice drugs for the treatment of Social Phobia, especially because of the serious adverse events, the possibility of a very severe hypertensive crisis due to interactions with substances (cheese) or medications with sympathomimetic actions. Worse, these crises can occur without any reason (endogenous or spontaneous hypertensive crises, Kline).

Clonazepam (Klonopin) was the medication most widely employed in the Anxiety and Depression Program of Federal University of Rio de Janeiro in the treatment of Social Phobia. More than 300 cases have been treated with this drug. This choice, now, is being reviewed.

The treatment is initiated with 2 mg/day of clonazepam (Klonopin) divided in two doses 1 mg lunch and 1 mg bed time. If the patient gets very sleepy he can stay for one week or even more with 1 mg bed time only. As tolerance develops the dose is increased to 3 mg/day. The ideal dose of clonazepam in the treatment of Social Phobia stays between 3 and 6 mg/day divided in three doses a day, morning, afternoon and bed time.

The therapeutic effect of clonazepam are very rapid, more so than we desired. One, two, three weeks in this schedule the patient starts to say that he is a new person, is doing things that he has never done before, signs in the front of others, goes to meetings, lunches in front of strangers, talks spontaneously with everybody, gives a talk to groups of people, his life has changed! The patient is marveled with the change and in this there is a danger. This change in behavior, so rapid, may result in problems with others who do not accept it or do not understand what is going on.

This therapeutic improvement with clonazepam may result in what we call disinhibition. Two cases can illustrate this. A lawyer who bought a gun and started to mingle in criminal actions going on in the city of Rio de Janeiro -- without a history of personality problems or aggressive tendencies -- a possible fatal side effect. Or, the wife who was housebound due to Social Phobia and after taking the medication starts to call former boyfriends and go out with them.

As we stated earlier the second generation medications moclobemide and especially the serotonin selective receptors inhibitors (SSRIs) may be very efficacious in the treatment of Social Phobia. We do have several cases showing this. Fluoxetine (Prozac) or paroxetine (Aropax, Paxil) should be given in doses between 20 and 60 mg/day, the first in the morning, the second either in the morning or at bed time. The therapeutic effects tend to appear after three weeks of treatment and are very significant. The case we talked about, the man with sweating crises is taking paroxetine 40 mg bed time and is assymptomatic.

The SSRIs are not devoid of unwanted effects. Most disturbing are sexual inhibition and weight gain, specially in the long term treatment. At this moment these drugs should be the first choices in the treatment of Social Phobia.

Marcio Versiani
Ivan Figueira, ilvf@mi.montreal.com.br
Anxiety and Depression Research Program
Federal University of Rio de Janeiro

Rua Visconde de Pirajá 407, sala 805
Rio de Janeiro, RJ
22410-003
Brazil

This article was written 16 May, 1996. Yes, it's dated and of questionable authority, but it gives me hope. I boldened the two areas that mean the most to me. Meds since 1996 have helped me only marginally. MAOIs and Benzos seem to be tried and true. (IMO)[/b]

[house]

I've been on Nardil for almost a month now with no real progress. 15mg x3 a day. Should I continue with a higher dose or switch meds?

[quat]

Originally Posted by house

I've been on Nardil for almost a month now with no real progress. 15mg x3 a day. Should I continue with a higher dose or switch meds?

Ask your doc first for an increase, but an effective dose for SA is about 75mg. I felt a difference within a couple of weeks on the lower dose.

[Chet]

It took about 6 weeks on nardil before I felt the effects at 60 mg to greatly reduce my depression- I still an dealing with more anxiety problems, I have just talked to my pdoc today and he recommended I increase my dose up to 90 mg in the next few weeks to help with anxiety. He agreed to let me supplement with Valium until the higher dose of nardil takes effect- But as with most pdoc's they will not prescibe benzo's long term....

[jakejohnson007]

I have mined through all of the search results on this entire message board with the word "Parnate" anywhere in them.

I found no instances of Parnate being ineffective for SA.

In every message I read, either:
I) Parnate was effective for people
2) people doubted Parnate's effectiveness, but none of these people had stayed on Parnate for over 6 months.
3) people quit Parnate due to side effects, NOT due to inefficacy.


I think I will go on an MAOI next month. Right now, i think Parnate may be a better choice than Nardil, but I have a month to mull it over.

[quat]

Get ready to do a lot of convincing with the doc. They don't seem to like prescribing Nardil. It might be easier to get it from a psych.

[house]

Originally Posted by quat

Get ready to do a lot of convincing with the doc. They don't seem to like prescribing Nardil. It might be easier to get it from a psych.

Just tell them your willing to accept the dietary restrictions and risks. You'll still probaly have to got through about a half dozen SSRI's but eventually you'll get it.

[jakejohnson007]

Quat, House, thanks for the heads up.

Actually, my psych is willing to perscribe MAOIs and said he would put me on EMSAM if I wanted to, next time I see him (1 month). However, as I've been mining through this board, I haven't found ANY situations where Parnate has not worked for someone. Parnate is less widely used than Nardil, so I need to look at Nardil posts in depth too.

But, I can ask my doc for Nardil or Parnate, and I can get them. I'll have a few weeks to decide which of the two I want.

I'm just amazed at how consistently effective MAOIs work (excluding cases where people quit before 2 months are over or quit due to side effects).

If an MAOI has not relieved SA for you, please post now.

I get more exited the longer this thread exists with no personal stories of MAOIs not working.

[jakejohnson007]

Found this from crazymeds.org :

> who's failed w/MAOIs?, tell me your experiences

Op

post Jan 9 2006, 04:47 AM
Post #1


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hey, i'm wondering who has failed with trials of MAOIs, and why didn't it work for you? and what was your experience with SSRIs? how had you failed with those and how did they compare with MAOIs?

This post has been edited by sunburnt22: Jan 9 2006, 04:49 AM

The post was made more than 13 months ago. It has 88 views and no replies.

source:
http://www.crazyboards.org/forums/index ... topic=8148[/quote]

[jakejohnson007]

As for effectiveness: Parnate has completely turned my depression around! I'm not sure I'm not still a bit depressed around the edges, but it's been amazing. And I stopped suicidal thinking within the four/six weeks (but increased very quickly). Since starting Parnate, I've written my dissertation, gone back to teaching two rather than one class a term, found my sense of humor, talk to people, and generally act and feel more like a 'non-depressed Fiona' than I have in six or seven years. I even see my pdoc/therp less! I assure you, I've been convinced for years that I would never never never feel like this again.

This one's from "Fiona", a moderator on crazyboards:
http://www.crazyboards.org/forums/index ... hl=parnate

[house]

Well the doc upped my dose to 60mg of Nardil and he said there is even more room after that, up to 90mg. This is common too since SA treatment usually requires the upper limits of medication. At 5 week Nardil does some to help my depression somewhat but we'll see on the SA. I'll post an update later.

[jakejohnson007]

Cool,

I'll be looking forward to your update. Good luck.

[house]

Well I believe after 3 weeks Nardil is finally starting to kick in. I don't feel completely better, but much better than I did on any SSRI. At my last doc visit we decided to keep the current dose (60mg /day) but still have room to move up later.

[Tommie]

I haven't tried Nardil or Parnate, but I have tried EMSAM (MAOI transdermal patch). I was on it for ~8 weeks, and it didn't help at all with social anxiety. It sort of helped with depression, but it gave me such terrible insomnia that it wasn't worth it.