Monoamine Oxidase Inhibitors (MAOIs)
|
|
This is one of the few class of meds with which neither Mouse nor I have had any personal experience. If all else fails, medication-wise, there are the MAOIs. Although I think they should be considered before the TCAs. Outside of the US you can find things like MAOI type B meds, reverse MAOIs and the MAOI patch, all of which deal in one way or another with the overwhelming lifestyle changes that come with MAOIs. The MAOIs work by inhibiting monoamine oxidase at your cerebellum, hence their name, as well as concentrating serotonin and norepinephrine in certain parts of the brain. For some forms of depression that's just all that is going to work. When the terms "atypical depression" and "treatment resistant" come up, the MAOIs are the drugs that break through that resistance. So why aren't they prescribed more often? Because they interact with a vast number of foods, prescription and non-prescription drugs, and often in a deadly way. So why aren't the other forms available in the US? Because the patents have expired, and enough money isn't to be made to please the shareholders. Maybe. There is testing of an MAOI patch in the US, so we'll see if anything comes of it. But if you're desperate and disciplined enough to exchange pizza, wine, coffee, chocolate, kim chee, sauerkraut, avocados, fava beans, aged cheeses, especially ripe bananas, practically every OTC medication and a host of other foods and prescription drugs, for potentially the only solution for otherwise insoluble depression, the MAOIs might be your last horsie on the med-go-round. Just be sure to wear a MedAlert bracelet noting that you're on an MAOI in case you're hospitalized, because no painkillers for you until the MAOI is out of your system, otherwise you too may wind up in a nineteen-day long coma. Then again, you may not be lucky enough to wake up. On top of that, the common side effects are similar to the SSRIs, in addition to dizziness being really popular. Plus you stand a chance freaky side effects like the TCAs, although the odds are a lot higher (i.e. it's less likely). And the MAOIs have their own discontinuation syndrome. But they really do work for some people when everything else fails, especially if Remeron worked for you before then pooped out. If only other options are wild experimentation with off-label meds of last resort and ECT give the MAOIs some decent consideration. I'm just going to cover the basics for now and where to get more information, if available. I'll update these meds to the new format after I deal with other meds, as these aren't prescribed very often, even though they probably should be prescribed more often. If and when that MAOI patch comes out we should see a lot more MAOI action, as the patch takes care of a lot of the problems associated with MAOIS. If you're down to the MAOIs, you need long talks with your doctor and a thorough reading of the patient information sheets. These drugs are not to be taken lightly. But in reading the experiences of people who have taken them, and comparing them with Mouse's experiences with the TCAs, if you have gone through all of the standard antidepressants and even some of the off-label medications, you're much better off giving the MAOIs a shot before the TCAs. For a lot more information on MAOIs, TCAs and how they compare to other antidepressants, I direct you to:
Antidepressant Comparison Chart by Loren Regier and Brent Jensen of
Queen's University School of Medicine,
Kingston Ontario. Of course it applies only for meds
available in Canada, eh. But it does cover SSRIs,
TCAs, MAOIs,
Multiple Reuptake Inhibitors and whatever else they
have in the Great White North. Which means all sorts of varieties of
MAOI you can't find in the US, but might get a doctor to prescribe for
you through a Canadian Pharmacy. For now, a glimpse of what the old Poppin' Zits! Consumers' Guide to Psychiatric Meds used to look like: |
| Marplan (isocarboxazid). Dosage should be started with one tablet (10 mg) of
Marplan twice daily. If tolerated, dosage may be increased by increments of one tablet (10
mg) every 2 to 4 days to achieve a dosage of four tablets daily (40 mg) by the end of the
first week of treatment. Dosage can then be increased by increments of up to 20 mg/week,
if needed and tolerated, to a maximum recommended dosage of 60 mg/day. Daily dosage should
be divided into two to four doses. After maximum clinical response is achieved, an attempt
should be made to reduce the dosage slowly over a period of several weeks without
jeopardizing the therapeutic response. Beneficial effect may not be seen in some patients
for 3 to 6 weeks. If no response is obtained by then, continued administration is unlikely
to help. No half-life data are provided. Hoffmann-La Roche.
For more information: http://www.fda.gov/cder/foi/label/1998/11961lbl.pdf
Nardil (phenelzine sulfate ) Initial dose: The usual starting dose of Nardil is one tablet (15 mg) three times a day. Early phase treatment: Dosage should be increased to at least 60 mg per day at a fairly rapid pace consistent with patient tolerance. It may be necessary to increase dosage up to 90 mg per day to obtain sufficient MAO inhibition. Many patients do not show a clinical response until treatment at 60 mg has been continued for at least 4 weeks. Maintenance dose: After maximum benefit from Nardil is achieved, dosage should be reduced slowly over several weeks. Maintenance dose may be as low as one tablet, 15 mg, a day or every other day, and should be continued for as long as is required. No half-life data are provided. Parke-Davis. For more information: www.fda.gov/cder/foi/label/2002/11909slr030lbl.pdf
Parnate (tranylcypromine sulfate). The usual effective dosage is 30 mg per day, usually given in divided doses. If there are no signs of improvement after a reasonable period (up to 2 weeks), then the dosage may be increased in 10 mg per day increments at intervals of 1 to 3 weeks; the dosage range may be extended to a maximum of 60 mg per day from the usual 30 mg per day. SmithKline Beecham. For more information: http://www.fda.gov/cder/foi/label/2001/12342s51lbl.pdf
|
The Overlords of the 12 Zernox Galaxies have compelled me through messages in the Sunday Chronicle to beg you for spare change. So if this site has been of use and/or amusement to you, please see if you could
or visit the Donation Page if PayPal isn't your style. Or our Mental Mall to make a purchase. Better yet, if you run a business and want to advertise on Crazy Meds, see our page on ad rates and policies. I'm all about fiscal transparency, so follow the money for full disclosure of my pitiful finances.
Crazy Meds Home Crazy Meds Talk About Antidepressants About SSRIs About Anticonvulsants / Mood Stabilizers About Atypical Antipsychotics About Benzodiazepines About Stimulants Finding a Doctor Sites with More Information Support Group Sites About Crazy Meds Visit my autistic - bipolar - epileptic blog
Save $5 on McAfee VirusScan Online
Take care, and keep taking your crazy meds!
Jerod
Hey, did you find this page all by itself through Google or some other search engine? Great! But to really appreciate the entire site, you need to start here.
Dead tree references:
Mosby's 2004 Drug Guide David Nissen PharmD, Editor.© 2004. An imprint of Elsevier. The edition we're using isn't listed on Amazon.
Physicians' Desk Reference Editions 53 & 56 Maria Deutsch & Anu Gupta, Drug Information Specialists, et al. © 2002. Published by Medical Economics Company.
Instant Psychopharmacology 2nd Edition Ronald J. Diamond M.D. © 2002. Published by W.W. Norton
The Complete Guide to Psychiatric Drugs Edward Drummond, M.D. © 2000. Published by John Wiley & Sons, Inc.
End of books used for this article.
--------------------------------------------------------------------------
Created Tuesday, November 11, 2003
Last updated Saturday, December 05, 2009
Copyright © 2003, 2004, 2005 Jerod Poore. All rights reserved.
Almost all of the material on this site is copyright © 2003, 2004, 2005 Jerod Poore. Except, of course, the PI sheets, those are the property of the drug companies who developed the drugs the sheets are about. And any documents that are written by other people which may be posted to this site will remain the property of the original authors. You cannot reproduce this page or any other material on this site outside of the boundaries of fair use copying without the express permission of the copyright holder. That's usually me, so just ask first. That means if want to print out a few pages to take to your doctor, therapist, counselor, support group, non-understanding family members or something like that - then that's OK to just do. Go for it! Please. As long as you include this copyright notice and the following disclaimer, I'm cool with it.
All rights reserved. No warranty is expressed or implied in this information. Consult one or more doctors and pharmacists before taking, or changing how you take any neurological and/or psychiatric medication. Your mileage may vary. What happened to us won't necessarily happen to you. Nobody on this site is a doctor, therapist, or a pharmacist. We don't portray them either here or on TV. Only doctors can diagnose and treat an illness. Some doctors tend to get pissed off by patients who know too much about medications, so tread lightly when and where appropriate. Diagnosing yourself from a website is like defending yourself in court, you suddenly have a fool for a doctor. Don't be a cyberchondriac, thinking you have every disease you see a website about, or that you'll get every side effect from every medication. Self-prescribing is just as dangerous. All information on this site has been obtained through personal experience, the experiences of my friends, the experiences of people reported on online support groups, and from sources that are referenced throughout the site. Know your sources! As such the information presented here is not a substitute for real medical advice from your real doctor, just a compliment to it. No neurologists, psychiatrists, therapists or pharmacists were harmed in the production of this website. All brand names of the drugs listed in this site are the trademarks of the companies listed after them in the pages about the drugs, even though those companies may or may not have been acquired by other companies who may or may not be listed in this site by the time you read this. Always read the PI sheet that comes with your medications and never ever throw them away. If you didn't get a PI sheet, demand one. Loudly. Crazy Meds is not responsible for the content of sites we provide links to. We like them, or they're paid advertisements, or they're something you should read to make an informed decision about a particular med. Sometimes they're more than one of those things. But what's on those sites is their business, not ours. Very little information about visitors to this site is collected or saved. And from time to time I do look at search terms used to find it in an effort to make the information I present more relevant. Use only as directed. Void where prohibited.
"Everything is true, nothing is permitted." - Jerod Poore
