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My psychiatrist is referring me to CAMH for medication management. This is obviously a question that only local people can answer, but, in anybody's experience, are they okay with prescribing MAOIS? The story is below if you're interested in reading it, but it's not necessary.

My psychiatrist was SUPPOSED to be switching me to Nardil (her idea) months ago but then changed her mind.

My biggest problem is social anxiety, but I also have atypical depression and generalized anxiety. She has me on a tricyclic right now, which has made absolutely no sense to me since the day she prescribed it.

So I wrote her a letter insisting I try an MAOI. I suggested Nardil or Parnate, and told her that since I'm taking a break from school for the year to deal with this ****, it doesn't matter if I can't tolerate because it won't interfere with anything important.

So when I met her earlier this week, she tells me MAOIs aren't really indicated for social anxiety, only depression, and she feels that my depression is really just a result of the social anxiety, and that she wants me to try Cymbalta instead... when I've already tried 2 ssris, wellbutrin, effexor, benzos, and a tricyclic, and have been seeing her for a year.

I thought... "WHATTT?" I didn't want to insult her (she is a young doctor who probably hasn't used MAOIs very much), but I told her that I am almost POSITIVE that MAOIs are considered to be the SINGLE MOST EFFECTIVE class of drugs for social anxiety.

So she pulled out a book she has that deals with treatment and prescribing guidelines. She flips to the page on social anxiety and tells me... "see... no MAOIs"

Maybe she wasn't counting on me being familiar with the generic names or something, but I take a closer look, and point out that both phenelzine and selegiline are actually in her book as second line treatments.... and I've tried more than enough drugs to be moving past "first line" treatments now.

Her response to that was to tell me that she's going to be referring me to CAMH. She says it's because she's never prescribed an MAOI for social anxiety before and she's not comfortable with it (isn't there supposed to be a first for everything? how do doctors ever prescribe anything with that attitude?)

Goddamn. I mean I really like the psychiatrist but I have to wonder what the hell they're learning when they do their 3 year specialty in psychiatry.

To give another example of what I mean by this...

I told her I suspected I've had ADHD-I since I was a kid and that it was overlooked because I was placed in a "gifted" program. She tells me no, I'm not hyperactive, and spends 10 minutes explaining to me why I'm wrong. But then she says that she definitely think it's probable I have ADD. What. The. ****. ADD has been an obsolete term for 15 years now, since the DSM-IV came out, and ADHD-I is what it's now referred to, which is why I called it that. And she is WAY too young to have been practicing medicine pre-DSM-IV.

So sorry for the life story, I needed to vent a little and thought this topic was appropriate. If CAMH tells me that Nardil isn't used for social anxiety and refuses to prescribe it, I really might just get things over with because there's no point in even trying anymore.
 
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